Organization
WK RED RIVER CARDIOVASCULAR SURGEONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4571
Entity
Organization
Contact information
Practice address
2751 ALBERT L BICKNELL DR, SUITE 5C, SHREVEPORT, LA 71103-3920
(318) 227-9777
(318) 459-1188
Mailing address
2551 GREENWOOD RD, SUITE 310, SHREVEPORT, LA 71103-3981
(318) 227-9777
(318) 459-1188
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356531
—
LA
Enumeration date
12/11/2008
Last updated
06/08/2012
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