Organization
WK PEDIATRIC GI SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 424-4232
Entity
Organization
Contact information
Practice address
2508 BERT KOUNS INDUSTRIAL LOOP, SUITE 101, SHREVEPORT, LA 71118-3133
(318) 212-5858
(318) 212-5877
Mailing address
2508 BERT KOUNS INDUSTRIAL LOOP, SUITE 101, SHREVEPORT, LA 71118-3133
(318) 212-5858
(318) 212-5877
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
—
—
2080P0206X
Pediatric Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2204943
—
TX
Enumeration date
01/28/2010
Last updated
07/21/2021
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