Organization
WK SHREVEPORT SLEEP MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-8780
Entity
Organization
Contact information
Practice address
1666 E BERT KOUN LOOP, SUITE 230, SHREVEPORT, LA 71105-5714
(318) 212-8780
(318) 212-6752
Mailing address
1666 E BERT KOUN LOOP, SUITE 230, SHREVEPORT, LA 71105-5714
(318) 212-8780
(318) 212-6752
Taxonomy
Speciality
Code
Description
License number
State
207QS1201X
Sleep Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
03/21/2017
Last updated
03/21/2017
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