Individual
DR. DORRIS BETHANY BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1905 SW HK DODGEN LOOP, TEMPLE, TX 76502-3498
(254) 298-2400
(254) 778-7197
Mailing address
1905 SW HK DODGEN LOOP, TEMPLE, TX 76502-3498
(254) 298-2400
(254) 778-7197
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
H3548
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8AA947
BLUE SHIELD
—
Enumeration date
03/23/2006
Last updated
10/01/2012
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