Organization
WK PELVIC & RECONSTRUCTIVE SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-8780
Entity
Organization
Contact information
Practice address
8001 YOUREE DR, SUITE 370, SHREVEPORT, LA 71115-2302
(318) 212-8780
(318) 212-6752
Mailing address
8001 YOUREE DR, SUITE 370, SHREVEPORT, LA 71115-2302
(318) 212-8780
(318) 212-6752
Taxonomy
Speciality
Code
Description
License number
State
2088F0040X
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
Primary
—
—
Other
Enumeration date
05/01/2017
Last updated
05/01/2017
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