Organization
WK GASTROENTEROLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4571
Entity
Organization
Contact information
Practice address
8001 YOUREE DR, SUITE 540, SHREVEPORT, LA 71115-2302
(318) 212-3787
(318) 212-3789
Mailing address
8001 YOUREE DR, SUITE 540, SHREVEPORT, LA 71115-2302
(318) 212-3787
(318) 212-3789
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1451941
—
LA
Enumeration date
05/04/2006
Last updated
06/08/2012
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