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Individual

SUSAN BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
2000 6TH AVE S, BIRMINGHAM, AL 35233-2110
(205) 801-8000
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
23465
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000098564
BLUE CROSS
AL
05
000098564
AL
01
000098566
BLUE CROSS
AL
05
000098566
AL
01
000098568
BLUE CROSS
AL
01
010033CD81185
SECTION 1011
AL
01
01726551
MISSISSIPPI MEDICAID
MS
01
050076491
RAILROAD MEDICARE
AL
01
D81185
VIVA
AL
Enumeration date
05/24/2006
Last updated
06/29/2023
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