Organization
J.K.S. PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORGE W BLACK MD (OWNER)
(318) 238-5040
Entity
Organization
Contact information
Practice address
740 KEYSER AVE, SUITE A-3, NATCHITOCHES, LA 71457-6037
(318) 238-5040
(318) 357-8842
Mailing address
740 KEYSER AVE, SUITE A-3, NATCHITOCHES, LA 71457-6037
(318) 238-5040
(318) 357-8842
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
201180
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05856513
ECFMG
LA
Enumeration date
11/21/2006
Last updated
07/24/2007
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