Organization
WK PEDIATRIC PULMONOLOGY SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-5780
Entity
Organization
Contact information
Practice address
2530 BERT KOUN LOOP, SUITE 114, SHREVEPORT, LA 71118-3132
(318) 212-5781
(318) 212-5785
Mailing address
2530 BERT KOUN LOOP, SUITE 114, SHREVEPORT, LA 71118-3132
(318) 212-5781
(318) 212-5785
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
—
—
Other
Enumeration date
08/27/2015
Last updated
08/27/2015
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