Black, Beau Stephen
Black, Beau Stephen is an individual health care provider with primary practice located at 5000 Hennessy Blvd , Baton Rouge LA 70808-4375. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Black, Beau Stephen can be contacted via phone (225) 757-0552.Contact Information
Primary practice address
5000 Hennessy Blvd
Baton Rouge LA 70808-4375
Phone: (225) 757-0552
Fax: (225) 763-9997
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | MD.203055 | Louisiana |
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X |
Profile Details
| NPI number | 1568621472 |
|---|---|
| LBN Legal business name | Black, Beau Stephen |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 5th, 2008 |
| Last updated | Jun 18th, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568621472 | NPPES |
| Louisiana | MEDICAID | 1084484 |
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