Organization
WK CTR FOR EAR NOSE AND THROAT DISORDERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
2300 HOSPITAL DR, SUITE 460, BOSSIER CITY, LA 71111-2394
(318) 212-7953
(318) 212-7955
Mailing address
2300 HOSPITAL DR, SUITE 460, BOSSIER CITY, LA 71111-2394
(318) 212-7953
(318) 212-7955
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Enumeration date
04/10/2013
Last updated
04/10/2013
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