Organization
WK BOSSIER ORTHOPEDIC & SPORTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4571
Entity
Organization
Contact information
Practice address
2449 HOSPITAL DR, SUITE 340, BOSSIER CITY, LA 71111-2382
(318) 212-7841
(318) 212-7846
Mailing address
2449 HOSPITAL DR, SUITE 340, BOSSIER CITY, LA 71111-2382
(318) 212-7841
(318) 212-7846
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1458651
—
LA
Enumeration date
01/15/2007
Last updated
06/08/2012
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