Organization
LAURA KIMBALL-RAVARI MD AND WILLIS-KNIGHTON MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-7902
Entity
Organization
Contact information
Practice address
2449 HOSPITAL DR, SUITE 400, BOSSIER CITY, LA 71111-2399
(318) 212-7902
(318) 212-7905
Mailing address
2449 HOSPITAL DR, SUITE 400, BOSSIER CITY, LA 71111-2399
(318) 212-7902
(318) 212-7905
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780610824
—
LA
Enumeration date
06/23/2006
Last updated
07/26/2010
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