Individual
CHARLES THOMAS BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12200 PARK CENTRAL DR STE 400, DALLAS, TX 75251-2116
(214) 483-9300
(214) 483-9301
Mailing address
12200 PARK CENTRAL DR STE 400, DALLAS, TX 75251-2116
(214) 483-9300
(214) 483-9301
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
F3761
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0134405
UNITED HEALTH CARE
TX
01
—
10009560
AMERIGROUP
TX
01
—
127631
SUPERIOR CHIP
TX
05
—
138311911
—
TX
05
—
138311913
—
TX
01
—
138311914
CSHCN
TX
01
—
153410004
PACIFICARE
TX
01
—
3725428015
CIGNA
TX
01
—
389962
ONE HEALTH PLAN
TX
01
—
4130343
AETNA
TX
01
—
41814
AETNA MEDICAID
TX
01
—
80390N
BLUE CROSS
—
Enumeration date
11/07/2005
Last updated
05/13/2020
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