Individual
HARRY H BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
201 NORTH CLYDE MORRIS BLVD, SUITE 100, DAYTONA BEACH, FL 32114-2724
(386) 238-3295
(386) 328-3273
Mailing address
PO BOX 9671, DAYTONA BEACH, FL 32120-9671
(386) 676-7130
(386) 676-7125
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME0048766
FL
2086S0127X
Trauma Surgery Physician
ME48766
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08331
BCBS
FL
01
—
1982691077
TRICARE
FL
05
—
275548300
—
FL
01
—
ME0048766
DCWO
FL
01
—
P00871769
RAILROAD MEDICARE
FL
Enumeration date
10/04/2005
Last updated
03/04/2016
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