Organization
WK BOSSIER PEDIATRIC PARTNERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
2300 HOSPITAL DR, SUITE 120, BOSSIER CITY, LA 71111-2394
(318) 212-7883
(318) 212-7885
Mailing address
2300 HOSPITAL DR, SUITE 120, BOSSIER CITY, LA 71111-2394
(318) 212-7883
(318) 212-7885
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2102583
—
LA
Enumeration date
03/30/2010
Last updated
06/12/2012
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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