Individual
SCOTT ALLEN BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
2200 BERGQUIST DR STE 1, LACKLAND A F B, TX 78236-9908
(210) 292-6707
Mailing address
2200 BERGQUIST DRIVE, SUITE 1, ATTN CREDENTIALS CMC, LACKLAND AFB, TX 78236-5300
(210) 292-7964
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
06/26/2007
Last updated
07/08/2007
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