Organization
WK BREAST HEALTH & SURGICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-8780
Entity
Organization
Contact information
Practice address
7843 YOUREE DR, SHREVEPORT, LA 71105-5505
(318) 212-8780
(318) 212-6752
Mailing address
7843 YOUREE DR, SHREVEPORT, LA 71105-5505
(318) 212-8780
(318) 212-6752
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
08/11/2016
Last updated
08/15/2016
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