Black, Bruce T
Black, Bruce T is an individual health care provider with primary practice located at 401 Baptist Dr Suite 104, Madison MS 39110-2009. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Black, Bruce T can be contacted via phone (601) 605-3858.Contact Information
Primary practice address
401 Baptist Dr Suite 104
Madison MS 39110-2009
Phone: (601) 605-3858
Fax: (601) 605-3898
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 18358 | Mississippi |
Profile Details
| NPI number | 1730199290 |
|---|---|
| LBN Legal business name | Black, Bruce T |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 8th, 2006 |
| Last updated | Feb 12th, 2018 - about 6 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 | 1730199290 | NPPES |
| Mississippi | MEDICAID | 07401794 |
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