Individual provider · NPI-1

Suzanne D Black, M.D.

Family Medicine · Bryan, TX

NPI number1720082167
StatusActive
Last updated in NPPESNov 19, 2014

Details

NPI
1720082167
Entity type
Individual (NPI-1)
Name
Suzanne D Black
Credential
M.D.
Sex
Female
Sole proprietor
Yes
Enumeration date
Jun 13, 2005
Last updated
Nov 19, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineH2250TXYes

Practice location

2714 Osler Blvd
Bryan, TX 77802-2517

Phone 979-776-7788 · Fax 797-776-0848

Mailing address

2714 Osler Blvd
Bryan, TX 77802-2517

Phone 979-776-7788 · Fax 797-776-0848

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