# FRED BLACK MD PC

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

## Provider details

- **NPI number:** 1710970330
- **Authorized official:** FREDERICK J BLACK MD (PRESIDENT)
- **Authorized official phone:** (541) 672-0497

## Contact information

- **Practice address:** 2282 NW TROOST ST, SUITE 103, ROSEBURG, OR 97471-6071
- **Practice address phone:** (541) 672-0497
- **Practice address fax:** (541) 957-2663
- **Mailing address:** 2282 NW TROOST ST, SUITE 103, ROSEBURG, OR 97471-6071
- **Mailing address phone:** (541) 672-0497
- **Mailing address fax:** (541) 957-2663

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD10476 | OR | Yes |

## Other

- **Enumeration date:** 08/30/2005
- **Last updated:** 11/21/2011