Fred Black MD PC

NPI #1710970330 in Roseburg, Oregon

Provider Information

NPI Number: 1710970330
Entity Type: Organization
Organization Name: Fred Black MD PC
Primary Specialty: Family Medicine
Enumeration Date: Aug 30, 2005
Last Updated: Nov 21, 2011

Practice Location

Address: 2282 NW TROOST ST
Address 2: SUITE 103
City: Roseburg
State: Oregon
ZIP Code: 97471-6071
Phone: (541) 672-0497

Authorized Official

Name: FREDERICK J BLACK, MD
Title: PRESIDENT
Phone: (541) 672-0497

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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