Organization
WK BOSSIER INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
2400 HOSPITAL DR, SUITE 420, BOSSIER CITY, LA 71111-2385
(318) 212-7910
(318) 752-7915
Mailing address
2400 HOSPITAL DR, SUITE 420, BOSSIER CITY, LA 71111-2385
(318) 212-7910
(318) 752-7915
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1025445
—
LA
Enumeration date
11/16/2007
Last updated
12/16/2009
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