Individual
DR. JUSTIN FREDERICK BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
301 MAIN PLZ # 170, NEW BRAUNFELS, TX 78130-5136
(830) 625-6700
Mailing address
301 MAIN PLZ # 170, NEW BRAUNFELS, TX 78130-5136
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
DO.00300
LA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
Q4035
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2149725
—
LA
Enumeration date
03/25/2011
Last updated
07/10/2015
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