Organization
WK BOSSIER SURGICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-8951
Entity
Organization
Contact information
Practice address
2400 HOSPITAL DR STE 250, BOSSIER CITY, LA 71111-2390
(318) 746-4460
(318) 746-3389
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 212-8951
(318) 212-6752
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
11/23/2018
Last updated
11/23/2018
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