# PAMELA O BLACK MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093752545
- **Authorized official:** TIMOTHY JACOBSON (CEO)
- **Authorized official phone:** (505) 343-1711

## Contact information

- **Practice address:** 3820 COMMONS AVE NE, ALBUQUERQUE, NM 87109-5831
- **Practice address phone:** (505) 343-1711
- **Practice address fax:** (505) 343-1862
- **Mailing address:** PO BOX 25206, ALBUQUERQUE, NM 87125-0206
- **Mailing address phone:** (505) 343-1711
- **Mailing address fax:** (505) 343-1862

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/01/2006
- **Last updated:** 12/13/2013