Organization
WK CHILD NEUROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-8780
Entity
Organization
Contact information
Practice address
2530 BERT KOUNS INDUSTRIAL LOOP, SUITE 113, SHREVEPORT, LA 71118-3132
(318) 212-5811
(318) 212-5844
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 212-5811
(318) 212-5844
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
—
—
Other
Enumeration date
07/24/2014
Last updated
07/24/2014
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