| NPI | 1255676870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG J GAVIN Network Administrator 318-212-4232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2012-12-07 |