Black, Timothy L

Black, Timothy L is an individual health care provider with primary practice located at 1500 Cooper St , Fort Worth TX 76104-2710. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Surgery, which is considered as his primary health care specialty. Black, Timothy L can be contacted via phone (682) 885-7080.

Contact Information

Primary practice address
1500 Cooper St Fort Worth TX 76104-2710
Phone: (682) 885-7080
Fax: (682) 885-7085
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Surgery 2086S0120X H1467 Texas

Profile Details

NPI number 1669453940
LBN Legal business name Black, Timothy L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 14th, 2005
Last updated Nov 5th, 2012 - about 13 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669453940 NPPES
Other 1750369203 NPI GROUP NUMBER
Other 8G3393 NPI GROUP NUMBER
MEDICAID 117647108 NPI GROUP NUMBER
MEDICAID 117647106 NPI GROUP NUMBER

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