Organization
WK NORTH DERMATOLOGY 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
2751 ALBERT L BICKNELL DR, SUITE 2-D, SHREVEPORT, LA 71103-3920
(318) 221-2623
(318) 424-9850
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 221-2623
(318) 424-9850
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
03/31/2009
Last updated
08/14/2013
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