TIMOTHY L BLACK MD NPI 1669453940

NPI Information

NPI: 1669453940
Provider Name: TIMOTHY L BLACK, MD
Classification: Surgery - 2086S0120X
Entity Type: Individual

Specialization: Pediatric Surgery

Address:
1500 COOPER ST
FORT WORTH, TX
ZIP 76104
Phone: (682) 885-7080
Get Directions

Timothy L Black, MD is a pediatric surgery surgery in Fort Worth, TX. The provider is a surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents. Timothy L Black, MD NPI is 1669453940. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1500 COOPER ST
FORT WORTH, TX
ZIP 76104-710
Phone: (682) 885-7080
Fax: (682) 885-7085

The enumeration date for this NPI number is 11/14/2005 and was last updated on 11/5/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2086S0120X	Surgery	Pediatric Surgery	H1467	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1750369203	OTHER		NPI GROUP NUMBER
2	8G3393	OTHER	TEXAS	BCBSTX PIN
3	117647108	MEDICAID	TEXAS
4	00U87Z	MEDICARE PIN	TEXAS
5	8G7178	MEDICARE PIN	TEXAS
6	117647106	MEDICAID	TEXAS
7	E79519	MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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