Organization
MONICA LAROSE HAYNES MD AND WILLIS-KNIGHTON MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-3930
Entity
Organization
Contact information
Practice address
7847 YOUREE DR, SHREVEPORT, LA 71105-5505
(318) 212-3930
(318) 212-3935
Mailing address
7847 YOUREE DR, SHREVEPORT, LA 71105-5505
(318) 212-3930
(318) 212-3935
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487082
—
LA
Enumeration date
06/25/2006
Last updated
12/14/2007
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