| Fred Black MD PC | |
|
2282 Nw Troost St Suite 103 Roseburg OR 97471-6071 | |
| (541) 672-0497 | |
| (541) 957-2663 |
| Full Name | Fred Black MD PC |
|---|---|
| Speciality | Family Medicine |
| Location | 2282 Nw Troost St, Roseburg, Oregon |
| Authorized Official Name and Position | Frederick J Black (PRESIDENT) |
| Authorized Official Contact | 5416720497 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fred Black MD PC 2282 Nw Troost St Suite 103 Roseburg OR 97471-6071 Ph: (541) 672-0497 | Fred Black MD PC 2282 Nw Troost St Suite 103 Roseburg OR 97471-6071 Ph: (541) 672-0497 |
| NPI Number | 1710970330 |
|---|---|
| Provider Enumeration Date | 08/30/2005 |
| Last Update Date | 11/21/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710970330 | NPI | - | NPPES |
| 218557 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD10476 (Oregon) | Primary |
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