Organization
WK NORTH BOSSIER ENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
2400 HOSPITAL DR, STE 260, BOSSIER CITY, LA 71111-2385
(318) 747-4988
(318) 747-1185
Mailing address
2400 HOSPITAL DR, STE 260, BOSSIER CITY, LA 71111-2385
(318) 747-4988
(318) 747-1185
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Enumeration date
12/03/2008
Last updated
12/03/2008
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