Organization
WK AND THE ASTHMA-ALLERGY CLINIC
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 345, BOSSIER CITY, LA 71111-2394
(318) 212-7780
(318) 212-7785
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 212-8946
(318) 212-4153
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
—
—
Other
Enumeration date
07/14/2010
Last updated
07/21/2010
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