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Individual
KEITH N BLACK
Active
Individual
KEITH N BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0320000253
VT
207Q00000X
Family Medicine Physician
1793
OK
207Q00000X
Family Medicine Physician
Primary
E9543
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108684100
FIRST CARE
TX
01
—
1186100001
CIGNA DMERC
TX
05
—
131469204
—
TX
01
—
132180100
SOUTHWEST LIFE & HEALTH
TX
01
—
80138267
RAILROAD MEDICARE
TX
01
—
84V315
BCBS
TX
01
—
E9543
UNICARE
TX
Enumeration date
07/26/2006
Last updated
03/01/2012
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