Organization
WK NORTH PULMONARY & CRITICAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
2551 GREENWOOD RD, SUITE 210, SHREVEPORT, LA 71103-3981
(318) 212-8946
(318) 212-4153
Mailing address
1202 LOUISIAN AVE., SHREVEPORT, LA 71101
(318) 212-8546
(318) 212-4153
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1099252
—
LA
Enumeration date
10/06/2006
Last updated
06/08/2012
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