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General NPI Number Information
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NPI Number | 1578546438
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Entity Type | Individual
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Provider Name | STEVEN R BLACK M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 405 W COUNTRY CLUB RD
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City | ROSWELL
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State | NM
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Zip | 88201-5209
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Country | US
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Telephone | 575-624-2095
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Fax | 575-208-0780
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Provider Business Mailing Address
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Address Line | PO BOX 8244
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City | ROSWELL
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State | NM
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Zip | 88202-8244
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Country | US
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Telephone | 575-624-2095
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Fax | 575-208-0780
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD2011-0547
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD2011-0547
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License Number State | NM
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