Organization
WK VASCULAR SURGICAL ASSOCIATES
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 5A, SHREVEPORT, LA 71103-3920
(318) 226-0058
(318) 226-1759
Mailing address
2751 ALBERT L BICKNELL DR, SUITE 5A, SHREVEPORT, LA 71103-3920
(318) 226-0058
(318) 226-1759
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
01/20/2010
Last updated
06/08/2012
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