Destin R. Black
Gynecologic Oncologist
2600 Kings Hwy Suite 420
Shreveport
, Louisiana 71103-3950
Destin R. Black
Gynecologic Oncologist
2600 Kings Hwy Suite 420
Shreveport
, Louisiana 71103-3950
(318) 212-8771
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About
Features
Specialties
- Gynecologic Oncologist
Languages spoken
- English
Location
First Address
- Destin R. Black
- 2600 Kings Hwy Suite 420
- Shreveport, LA
- Zip : 71103-3950
- Fax : (318) 212-8771
- Phone : (318) 212-8727
Second Address
- Destin R. Black
- 2600 Kings Hwy Suite 420
- Shreveport, LA
- Zip : 71103-3950
- Fax : (318) 212-8771
- Phone : (318) 212-8727
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207VX0201X | Gynecologic Oncologist | 024725 | LA |
National Provider Identifier
| NPI | 1306062625 |
|---|---|
| Provider Name | Destin R. Black |
| First Address | Shreveport, LA 71103-3950 |
| Second Address | Shreveport, LA 71103-3950 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 17/04/2007 |
| Last Update Date | 18/06/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 1577936 | (05) | LA |
| 4K574F600 | MEDICARE - PTAN (01) | LA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.