MEDICARE: HARRY H BLACK MD

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	208600000X	Surgery Physician	ME0048766	FL
2	2086S0127X	Trauma Surgery Physician	ME48766	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00871769	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME0048766	OTHER	FL	DCWO
2	08331	OTHER	FL	BCBS
4	ME0048766	OTHER	FL	VHN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1982691077	OTHER	FL	TRICARE

General Provider Information

NPI Number	:	1982691077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRY H BLACK MD

Provider Business Mailing Address
First Line	:	PO BOX 9671
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32120-9671
Country	:	US
Telephone Number	:	386-676-7130
Fax Number	:	386-676-7125

Provider Business Practice Location Address
First Line	:	201 NORTH CLYDE MORRIS BLVD
Second Line	:	SUITE 100
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-2724
Country	:	US
Telephone Number	:	386-238-3295
Fax Number	:	386-328-3273

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	03/04/2016

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Directions to “ HARRY H BLACK MD” Practice Location

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