Timothy L Black
Pediatric Surgery
1500 Cooper St
Fort Worth
, Texas 76104-2710
Timothy L Black
Pediatric Surgery
1500 Cooper St
Fort Worth
, Texas 76104-2710
(682) 885-1903
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About
Features
Specialties
- Pediatric Surgery
Languages spoken
- English
Location
First Address
- Timothy L Black
- Po Box 99371
- Fort Worth, TX
- Zip : 76199-0371
- Fax : (682) 885-1903
- Phone : (682) 885-4157
Second Address
- Timothy L Black
- 1500 Cooper St
- Fort Worth, TX
- Zip : 76104-2710
- Fax : (682) 885-7085
- Phone : (682) 885-7080
Reviews
FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2086S0120X | Pediatric Surgery | H1467 | TX |
National Provider Identifier
| NPI | 1669453940 |
|---|---|
| Provider Name | Timothy L Black |
| First Address | Fort Worth, TX 76199-0371 |
| Second Address | Fort Worth, TX 76104-2710 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 14/11/2005 |
| Last Update Date | 05/11/2012 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 117647106 | (05) | TX |
| 117647108 | (05) | TX |
| 1750369203 | NPI GROUP NUMBER (01) | |
| 8G3393 | BCBSTX PIN (01) | TX |
| E79519 | (02) |
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.