Organization
WK ORTHOPEDIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
7925 YOUREE DR, SUITE 200, SHREVEPORT, LA 71105-5127
(318) 212-3610
(318) 212-3672
Mailing address
7925 YOUREE DR, SUITE 200, SHREVEPORT, LA 71105-5127
(318) 212-3610
(318) 212-3672
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1452891
—
LA
Enumeration date
06/28/2006
Last updated
02/05/2013
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