WK Portico Pediatrics

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

WK PORTICO PEDIATRICS

Practice address

7847 Youree Dr
Shreveport, LA 71105-5505

Phone

(318) 212-3930

Fax

(318) 212-3935

NPI assigned

Oct 23, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Greg J. Gavin

Title

Network Administrator

Phone

(318) 212-4232

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256256000000",
    "number": "1083940191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7847 YOUREE DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055505",
            "telephone_number": "318-212-3930",
            "fax_number": "318-212-3935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7847 YOUREE DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055505",
            "telephone_number": "318-212-3930",
            "fax_number": "318-212-3935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK PORTICO PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-23",
        "last_updated": "2009-10-23",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "NETWORK ADMINISTRATOR",
        "authorized_official_telephone_number": "318-212-4232"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.