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DR. CLIFFORD P. BLACK M.D.
>> Specialist >> Other Service ProvidersRegistrant NPI Number: 1316903396
Individual Registrant:DR. CLIFFORD P. BLACK M.D.
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
1901 LEIGHTON AVE ANNISTON, AL 36207-3270 US
Tel: 256-240-9660 Fax: 256-240-9636
Tel: 256-240-9660 Fax: 256-240-9636
Contact information for business:
1901 LEIGHTON AVE ANNISTON, AL 36207-3270 US
Tel: 256-240-9660 Fax: 256-240-9636
Tel: 256-240-9660 Fax: 256-240-9636
Registration Information:
NPI: 1316903396
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 174400000X | Other Service Providers Specialist | AL | 00014219 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD | 051044834 | AL | 01 |
| 000044834 | AL | 05 |
