Individual
DR. WILLIAM H BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-8000
Mailing address
2500 N STATE ST, UMMC-DEPARTMENT OF DERMATOLOGY, JACKSON, MS 39216-4500
(601) 815-3374
(601) 853-6307
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
22568
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05637711
—
MS
01
—
P01454816
RAILROAD MEDICARE PTAN
MS
Enumeration date
06/05/2008
Last updated
10/06/2017
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