Organization
WK WOMENS SPECIALISTS AT SOUTH
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 KOUN LOOP, SUITE 112, SHREVEPORT, LA 71118-3132
(318) 212-5969
(318) 212-5979
Mailing address
2530 BERT KOUN LOOP, SUITE 112, SHREVEPORT, LA 71118-3132
(318) 212-5969
(318) 212-5979
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
06/10/2014
Last updated
06/10/2014
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