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
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