| J. Larry Black Md Phd Pllc | |
|
4364 Hwy 51 South Senatobia MS 38668-2534 | |
| (662) 562-6026 | |
| (662) 562-8037 |
| Full Name | J. Larry Black Md Phd Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4364 Hwy 51 South, Senatobia, Mississippi |
| Authorized Official Name and Position | J Larry Black (PRESIDENT) |
| Authorized Official Contact | 6625626026 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| J. Larry Black Md Phd Pllc 4364 Hwy 51 South Senatobia MS 38668-2534 Ph: (662) 562-6026 | J. Larry Black Md Phd Pllc 4364 Hwy 51 South Senatobia MS 38668-2534 Ph: (662) 562-6026 |
| NPI Number | 1326239856 |
|---|---|
| Provider Enumeration Date | 08/08/2007 |
| Last Update Date | 12/17/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326239856 | NPI | - | NPPES |
| 09015649 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD0000008543 (Mississippi) | Primary |
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