Organization
WK NORTH SHREVEPORT FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 222-5270
Entity
Organization
Contact information
Practice address
3312 N MARKET ST, SHREVEPORT, LA 71107-4009
(318) 222-5270
(318) 221-4559
Mailing address
3312 N MARKET ST, SHREVEPORT, LA 71107-4009
(318) 222-5270
(318) 221-4559
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
06/19/2006
Last updated
06/08/2012
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