Individual
DR. CHARLES BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1534 ELIZABETH AVE, SUITE 202, SHREVEPORT, LA 71101-4516
(318) 681-7350
(318) 681-7351
Mailing address
1534 ELIZABETH AVE, SUITE 202, SHREVEPORT, LA 71101-4516
(318) 681-7350
(318) 681-7351
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
L011576
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1169838
—
LA
Enumeration date
06/05/2006
Last updated
09/14/2007
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