Black, Suzanne D
Black, Suzanne D is an sole proprietor health care provider with primary practice located at 2714 Osler Blvd , Bryan TX 77802-2517. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Black, Suzanne D can be contacted via phone (979) 776-7788.Contact Information
Primary practice address
2714 Osler Blvd
Bryan TX 77802-2517
Phone: (979) 776-7788
Fax: (797) 776-0848
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | H2250 | Texas |
Profile Details
| NPI number | 1720082167 |
|---|---|
| LBN Legal business name | Black, Suzanne D |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 13th, 2005 |
| Last updated | Nov 19th, 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 | 1720082167 | NPPES |
| Texas | MEDICAID | 133493001 | |
| Texas | Other | 00T34F | |
| Texas | MEDICAID | 133493007 |
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