Healthcare Provider Details

I. General information

NPI: 1598939340
Provider Name (Legal Business Name): MARK A BLACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 NE 13TH ST # 1200
OKLAHOMA CITY OK
73117-1039
US

IV. Provider business mailing address

1122 NE 13TH ST # 1200
OKLAHOMA CITY OK
73117-1039
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-8558
  • Fax:
Mailing address:
  • Phone: 405-271-8558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number46888
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME-124249
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number46888
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number253622
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: