Healthcare Provider Details

I. General information

NPI: 1366488173
Provider Name (Legal Business Name): KARL K BILDERBACK, MD AND WILLIS-KNIGHTON MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7925 YOUREE DR SUITE 200
SHREVEPORT LA
71105-5538
US

IV. Provider business mailing address

7925 YOUREE DR SUITE 200
SHREVEPORT LA
71105-5538
US

V. Phone/Fax

Practice location:
  • Phone: 318-798-6700
  • Fax: 318-798-6799
Mailing address:
  • Phone: 318-798-6700
  • Fax: 318-798-6799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GREG J. GAVIN
Title or Position: NETWORK ADMINISTRATOR
Credential:
Phone: 318-798-6700