Provider Demographics
NPI:1801872551
Name:BLACK, CHRISTOPHER SEAN FATTE (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:SEAN FATTE
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 WALNUT HILL LN
Mailing Address - Street 2:PEROT SUITE 007
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4339
Mailing Address - Country:US
Mailing Address - Phone:214-345-5930
Mailing Address - Fax:
Practice Address - Street 1:8160 WALNUT HILL LN
Practice Address - Street 2:PEROT SUITE 007
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4339
Practice Address - Country:US
Practice Address - Phone:214-345-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7752207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0011EKOtherBCBS
TX89191FOtherBCBS
TX126641305Medicaid
TX126641301Medicaid
TX930078715OtherMEDICARE RAILROAD
TX00407LMedicare PIN
TX126641301Medicaid
TX89191FOtherBCBS
TX930092989Medicare PIN