Wk Portico Pediatrics

NPI #1083940191 in Shreveport, Louisiana

Provider Information

NPI Number: 1083940191
Entity Type: Organization
Organization Name: Wk Portico Pediatrics
Primary Specialty: Pediatrics
Enumeration Date: Oct 23, 2009
Last Updated: Oct 23, 2009

Practice Location

Address: 7847 YOUREE DR
City: Shreveport
State: Louisiana
ZIP Code: 71105-5505
Phone: (318) 212-3930

Authorized Official

Name: GREG J. GAVIN
Title: NETWORK ADMINISTRATOR
Phone: (318) 212-4232

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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