Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 044471 | CT |
N | 208600000X | Surgeon | 044471 | CT |
N | 208200000X | Surgeon | 223910 | MA |
N | 208600000X | Surgeon | 223910 | MA |
Y | 2086X0206X | Surgical Oncologist | 43694 | TX |
NPI | 1295725794 |
---|---|
Provider Name | Dr. Dalliah Mashon Black |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 01/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
286882001 (MDACC) | (05) | TX |
468419 | TUFTS HEALTH PLAN (01) | MA |
8DB287 | BCBS (MDACC) (01) | TX |
H65403 | (02) | |
J28934 | BCBS MA (01) | MA |