Provider Demographics
NPI:1457884819
Name:WK CENTER FOR ENDOCRINOLOGY AND DIABETES
Entity Type:Organization
Organization Name:WK CENTER FOR ENDOCRINOLOGY AND DIABETES
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:318-212-8780
Mailing Address - Street 1:2551 GREENWOOD RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3984
Mailing Address - Country:US
Mailing Address - Phone:318-212-8627
Mailing Address - Fax:318-212-8632
Practice Address - Street 1:2551 GREENWOOD RD
Practice Address - Street 2:SUITE 411
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3981
Practice Address - Country:US
Practice Address - Phone:318-212-8627
Practice Address - Fax:318-212-8632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty