Individual
DR. CHARLES LEONARD BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7600 GENERAL MOTORS BLVD, MEDICAL DEPARTMENT, SHREVEPORT, LA 71129-9426
(318) 683-9503
(318) 683-9697
Mailing address
6006 E RIDGE DR, SHREVEPORT, LA 71106-2426
(318) 861-7555
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
015534
LA
Other
Enumeration date
01/19/2007
Last updated
07/08/2007
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