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Individual
SUSAN BLACK
Active
Individual
SUSAN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
23465
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000098564
BLUE CROSS
AL
05
—
000098564
—
AL
01
—
000098566
BLUE CROSS
AL
05
—
000098566
—
AL
01
—
000098568
BLUE CROSS
AL
01
—
010033CD81185
SECTION 1011
AL
01
—
01726551
MISSISSIPPI MEDICAID
MS
01
—
050076491
RAILROAD MEDICARE
AL
01
—
D81185
VIVA
AL
Enumeration date
05/24/2006
Last updated
06/29/2023
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