Provider Demographics
NPI:1902808827
Name:BLACK, ROBERT D (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3600 GASTON AVENUE
Mailing Address - Street 2:SUITE 806
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1808
Mailing Address - Country:US
Mailing Address - Phone:214-824-8521
Mailing Address - Fax:214-827-8840
Practice Address - Street 1:3600 GASTON AVENUE
Practice Address - Street 2:SUITE 806
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1808
Practice Address - Country:US
Practice Address - Phone:214-824-8521
Practice Address - Fax:214-827-8840
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF6448207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099771002Medicaid
TX80256NMedicare ID - Type Unspecified
TXC13494Medicare UPIN