MEDICARE: MARK A BLACK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	46888	OK
2	207P00000X	Emergency Medicine Physician	253622	NY
3	207P00000X	Emergency Medicine Physician	ME-124249	FL

General Provider Information

NPI Number	:	1598939340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A BLACK M.D.

Provider Business Mailing Address
First Line	:	1122 NE 13TH ST # 1200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-1039
Country	:	US
Telephone Number	:	405-271-8558
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 NE 13TH ST # 1200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-1039
Country	:	US
Telephone Number	:	405-271-8558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	05/27/2026

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