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Organization

WK CENTER FOR PEDIATRICS - SOUTH

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization

Contact information

Practice address
2518 BERT KOUNS LOOP, SHREVEPORT, LA 71118-3112
(318) 212-5437
Mailing address
2518 BERT KOUNS LOOP, SHREVEPORT, LA 71118-3112
(318) 212-5437

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1025526
LA
Enumeration date
11/20/2007
Last updated
01/26/2016
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