Provider Demographics
NPI:1992818355
Name:BLACK, JAMES A (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4007 JAMES CASEY ST
Mailing Address - Street 2:SUITE C-110
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3369
Mailing Address - Country:US
Mailing Address - Phone:512-707-8100
Mailing Address - Fax:512-707-8101
Practice Address - Street 1:4007 JAMES CASEY ST
Practice Address - Street 2:SUITE C-110
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3369
Practice Address - Country:US
Practice Address - Phone:512-707-8100
Practice Address - Fax:512-707-8101
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2011-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXD99462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185569401Medicaid
612690Medicare PIN
A06105Medicare UPIN