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General NPI Number Information
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NPI Number | 1891375465
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Entity Type | Individual
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Provider Name | SAMANTHA MONIQUE BLACK MD
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Gender | Female
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 1615 HOSPITAL PKWY STE 306
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City | BEDFORD
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State | TX
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Zip | 76022-5936
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Country | US
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Telephone | 817-684-5100
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Fax | 817-684-5101
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Provider Business Mailing Address
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Address Line | 7300 RANCH ROAD 2222, BLDG 1, STE 200
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City | AUSTIN
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State | TX
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Zip | 78730-3255
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Country | US
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Telephone | 512-628-0465
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Fax | 512-233-2711
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | V6875
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License Number State | TX
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