Individual
DR. CHARLES HENRY BLACK IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1000 GREENLEY RD, SONORA, CA 95370-5200
(209) 536-5054
Mailing address
PO BOX 247, LAUREL, MS 39441-0247
(601) 649-5990
(601) 425-7510
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
20A24530
CA
207X00000X
Orthopaedic Surgery Physician
Primary
23113
MS
207X00000X
Orthopaedic Surgery Physician
5101016776
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08107236
—
MS
Enumeration date
06/06/2007
Last updated
01/12/2026
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