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NPI Code Detail

MEDICARE: DR. ANDREW WILLIAM BLACK M.D.

MEDICARE: DR. ANDREW WILLIAM 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
1207RG0100XGastroenterology PhysicianME86151FL

General Provider Information

NPI Number : 1851392351
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDREW WILLIAM BLACK M.D.
Provider Business Mailing Address
First Line : 1125 N PORTER AVE STE 301
Second Line :
City : NORMAN
State : OK
Zip : 73071-6443
Country : US
Telephone Number : 405-360-2777
Fax Number : 405-360-2780
Provider Business Practice Location Address
First Line : 1125 N PORTER AVE STE 301
Second Line :
City : NORMAN
State : OK
Zip : 73071-6443
Country : US
Telephone Number : 405-360-2777
Fax Number : 405-360-2780
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 03/22/2019

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