Organization
WK RIVER CITIES INTERVENTIONAL PAIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-8085
Entity
Organization
Contact information
Practice address
1811 E BERT KOUNS INDUSTRIAL LOOP, SUITE 300, SHREVEPORT, LA 71105-5740
(318) 212-3636
(318) 212-3649
Mailing address
1811 E BERT KOUNS INDUSTRIAL LOOP, SUITE 300, SHREVEPORT, LA 71105-5740
(318) 212-3636
(318) 212-3649
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1448222
—
LA
Enumeration date
06/20/2006
Last updated
06/08/2012
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