Individual
FREDERICK J BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2282 NW TROOST ST, SUITE 103, ROSEBURG, OR 97470-6071
(541) 672-0497
(541) 957-2663
Mailing address
2282 NW TROOST ST, SUITE 103, ROSEBURG, OR 97470-6071
(541) 672-0497
(541) 957-2663
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD10476
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
225581
—
OR
Enumeration date
02/15/2007
Last updated
10/23/2007
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