Organization
WK SOUTH SHREVEPORT FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
2520 BERT KOUNS LOOP STE 102, SHREVEPORT, LA 71118-3130
(318) 212-5972
(318) 212-5369
Mailing address
2520 BERT KOUNS LOOP STE 102, SHREVEPORT, LA 71118-3130
(318) 212-5972
(318) 212-5369
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
01/14/2008
Last updated
06/08/2012
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