Provider Demographics
NPI:1386949774
Name:STEPHEN T. BLACK, MD., PA
Entity type:Organization
Organization Name:STEPHEN T. BLACK, MD., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-770-6300
Mailing Address - Street 1:PO BOX 226741
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-6741
Mailing Address - Country:US
Mailing Address - Phone:888-854-3822
Mailing Address - Fax:817-877-0350
Practice Address - Street 1:4204 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6440
Practice Address - Country:US
Practice Address - Phone:214-327-3468
Practice Address - Fax:817-877-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-17
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2501207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty