NPI 1730199290 · live from the CMS NPI Registry
Bruce T Black, M.D.
Family Medicine in Madison, MS. National Provider Identifier 1730199290, active.
NPI record
| NPI | 1730199290 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine 207Q00000X |
| Practice location | 401 Baptist Dr, Suite 104, Madison, MS 39110 |
| Practice phone | 601-605-3858 |
| Mailing address | 965 Ridge Lake Blvd Ste 103, Memphis, TN 38120 |
| Enumerated | August 8, 2006 |
| Last updated | February 12, 2018 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine primary | 207Q00000X | 18358 (MS) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.