Individual
BRUCE T BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 BAPTIST DR, SUITE 104, MADISON, MS 39110-2009
(601) 605-3858
(601) 605-3898
Mailing address
965 RIDGE LAKE BLVD STE 103, MEMPHIS, TN 38120-9446
(901) 227-3255
(901) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18358
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07401794
—
MS
Enumeration date
08/08/2006
Last updated
02/12/2018
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