Organization
WK NORTH ORTHOPEDIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
2751 ALBERT L BICKNELL DR, SUITE 1-B, SHREVEPORT, LA 71103-3920
(318) 212-8776
(318) 212-8774
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 212-8776
(318) 212-8774
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447838
—
LA
Enumeration date
12/28/2005
Last updated
06/08/2012
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