Organization
WK SPINE INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
2551 GREENWOOD RD, SUITE 320, SHREVEPORT, LA 71103-3981
(318) 212-8546
(318) 212-4153
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 212-4889
(318) 212-4153
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Enumeration date
01/22/2010
Last updated
09/16/2010
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