MEDICARE: DR. DAWN DICKSON 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	207V00000X	Obstetrics & Gynecology Physician	H9803	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	83041G	OTHER	TX	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1710980909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAWN DICKSON BLACK M.D.

Provider Business Mailing Address
First Line	:	7900 FANNIN ST STE 4000
Second Line	:	OBGYN MEDICAL CENTER, PLLC
City	:	HOUSTON
State	:	TX
Zip	:	77054-2934
Country	:	US
Telephone Number	:	713-512-7500
Fax Number	:	713-512-7927

Provider Business Practice Location Address
First Line	:	7900 FANNIN ST STE 4000
Second Line	:	OBGYN MEDICAL CENTER, PLLC
City	:	HOUSTON
State	:	TX
Zip	:	77054-2934
Country	:	US
Telephone Number	:	713-512-7500
Fax Number	:	713-512-7927

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	09/15/2015

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