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General NPI Number Information
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NPI Number | 1427010289
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Entity Type | Individual
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Provider Name | STEPHEN BLACK MD
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Gender | Male
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5001 SPRIG VALLEY RD STE 400 EAST
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City | DALLAS
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State | TX
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Zip | 75244
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Country | US
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Telephone | 972-383-1366
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Fax |
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Provider Business Mailing Address
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Address Line | 804 SCOTT NIXON MEMORIAL DR
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City | AUGUSTA
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State | GA
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Zip | 30907-2464
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | J2501
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License Number State | TX
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