Provider Demographics
NPI:1548746852
Name:WK ADULT MEDICINE SPECIALISTS
Entity Type:Organization
Organization Name:WK ADULT MEDICINE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NETWORK ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:J
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-212-8951
Mailing Address - Street 1:2508 BERT KOUN LOOP STE 300
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3100
Mailing Address - Country:US
Mailing Address - Phone:318-212-5757
Mailing Address - Fax:318-212-5779
Practice Address - Street 1:2508 BERT KOUN LOOP STE 300
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3100
Practice Address - Country:US
Practice Address - Phone:318-212-5757
Practice Address - Fax:318-212-5779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty