Organization
WK MID SOUTH ORTHOPEDICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
7925 YOUREE DR, SUITE 220, SHREVEPORT, LA 71105-5127
(318) 424-3400
(318) 798-9562
Mailing address
7925 YOUREE DR, SUITE 220, SHREVEPORT, LA 71105-5127
(318) 424-3400
(318) 798-9562
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015130
—
LA
Enumeration date
08/08/2007
Last updated
06/08/2012
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