Organization
WK SHREVEPORT BREAST CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
8001 YOUREE DR, SUITE 960, SHREVEPORT, LA 71115-2302
(318) 212-3706
(318) 212-3708
Mailing address
8001 YOUREE DR, SUITE 960, SHREVEPORT, LA 71115-2302
(318) 212-3706
(318) 212-3708
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447064
—
LA
Enumeration date
07/01/2006
Last updated
06/08/2012
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