Organization
WK PIERREMONT PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
1811 E BERT KOUNS INDUSTRIAL LOOP, SUITE 140, SHREVEPORT, LA 71105-5563
(318) 797-9000
(318) 797-9275
Mailing address
1811 E BERT KOUNS INDUSTRIAL LOOP, SUITE 140, SHREVEPORT, LA 71105-5563
(318) 797-9000
(318) 797-9275
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1448907
—
LA
Enumeration date
06/05/2007
Last updated
06/12/2012
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