Provider Demographics
NPI:1316905987
Name:BLACK, JAMES A (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:BLACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 CANTERBURY
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601
Mailing Address - Country:US
Mailing Address - Phone:785-628-3131
Mailing Address - Fax:785-628-3650
Practice Address - Street 1:2517 CANTERBURY
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601
Practice Address - Country:US
Practice Address - Phone:785-628-3131
Practice Address - Fax:785-628-3650
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0524331207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100232570BMedicaid
KS100232570BMedicaid
049041Medicare PIN