Organization
J. LARRY BLACK MD PHD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
J LARRY BLACK MD (PRESIDENT)
(662) 562-6026
Entity
Organization
Contact information
Practice address
4364 HWY 51 SOUTH, SENATOBIA, MS 38668-2534
(662) 562-6026
(662) 562-8037
Mailing address
4364 HWY 51 SOUTH, SENATOBIA, MS 38668-2534
(662) 562-6026
(662) 562-8037
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD0000008543
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015649
—
MS
Enumeration date
08/08/2007
Last updated
12/17/2007
Update your record
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