Individual
PAUL CLIFFORD BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 LANTANA RD STE 202, CROSSVILLE, TN 38555-1903
(931) 484-5141
(865) 374-2074
Mailing address
1000 GW LN, WAYNESVILLE, MO 65583-2339
(573) 774-2715
(573) 202-2410
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101244723
VA
207Q00000X
Family Medicine Physician
Primary
2020030965
MO
207Q00000X
Family Medicine Physician
44017
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
165699202
BLACK LUNG
—
01
—
621584391013
TRICARE
—
05
—
Q009679
—
TN
Enumeration date
08/08/2007
Last updated
05/27/2025
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