Individual
DR. JASON L. BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3109 BIENVILLE BLVD, DEPARTMENT OF EMERGENCY MEDICINE, OCEAN SPRINGS, MS 39564-4361
(228) 818-1111
Mailing address
3109 BIENVILLE BLVD, DEPARTMENT OF EMERGENCY MEDICINE, OCEAN SPRINGS, MS 39564-4361
(228) 818-1111
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
T-2070
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20838
PERMANENT LICENSE NUMBER
MS
Enumeration date
07/06/2008
Last updated
06/20/2013
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