Organization
WK NW LOUISIANA INFECTIOUS DISEASE CONSULTANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-8780
Entity
Organization
Contact information
Practice address
2551 GREENWOOD RD, SUITE 150, SHREVEPORT, LA 71103-3981
(318) 212-6888
(318) 212-6890
Mailing address
2551 GREENWOOD RD, SUITE 150, SHREVEPORT, LA 71103-3981
(318) 212-6888
(318) 212-6890
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
268368
MEDICARE PTAN
LA
Enumeration date
10/30/2012
Last updated
08/27/2013
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