Basic Information
| Provider Information | |||||||||
| NPI: | 1376570614 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAM D PARKER MD AND WILLIS-KNIGHTON MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7847 YOUREE DR | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711055505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182123930 | ||||||||
| FaxNumber: | 3182123935 | ||||||||
| Practice Location | |||||||||
| Address1: | 7847 YOUREE DR | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711055505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182123930 | ||||||||
| FaxNumber: | 3182123935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GAVIN | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | NETWORK ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3182123930 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.