Organization
WK PREMIER PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-8780
Entity
Organization
Contact information
Practice address
2300 HOSPITAL DR, SUITE 420, BOSSIER CITY, LA 71111-2394
(318) 212-7880
(318) 212-7978
Mailing address
2300 HOSPITAL DR, SUITE 420, BOSSIER CITY, LA 71111-2394
(318) 212-7880
(318) 212-7978
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
09/10/2015
Last updated
09/10/2015
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