Organization
WK SOUTH ORTHOPEDIC 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
2520 BERT KOUNS LOOP, SUITE 105, SHREVEPORT, LA 71118-3130
(318) 212-5886
(318) 212-5889
Mailing address
2520 BERT KOUNS LOOP, SUITE 105, SHREVEPORT, LA 71118-3130
(318) 212-5886
(318) 212-5889
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Enumeration date
05/03/2011
Last updated
05/03/2011
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