Individual
BEAU STEPHEN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5000 HENNESSY BLVD, BATON ROUGE, LA 70808-4375
(225) 757-0552
(225) 763-9997
Mailing address
8230 SUMMA AVE STE C, BATON ROUGE, LA 70809-3465
(225) 757-0552
(225) 763-9997
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD.203055
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1084484
—
LA
Enumeration date
06/05/2008
Last updated
06/18/2014
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