Individual
TIMOTHY L BLACK
Active
Individual
TIMOTHY L BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
H1467
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117647106
—
TX
05
—
117647108
—
TX
01
—
1750369203
NPI GROUP NUMBER
—
01
—
8G3393
BCBSTX PIN
TX
Enumeration date
11/14/2005
Last updated
11/05/2012
Update your record
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