Fred Black MD PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD10476 Issued in OR

Legal business name

FRED BLACK MD PC

Practice address

2282 NW Troost St
Suite 103
Roseburg, OR 97471-6071

Phone

(541) 672-0497

Fax

(541) 957-2663

NPI assigned

Aug 30, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Frederick J Black, MDNPI 1942343074

Title

President

Phone

(541) 672-0497

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Frederick J Black, MD

  • Family Medicine Physician
  • Roseburg, OR
  • NPI 1942343074
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321833600000",
    "number": "1710970330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2282 NW TROOST ST",
            "address_2": "SUITE 103",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974716071",
            "telephone_number": "541-672-0497",
            "fax_number": "541-957-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2282 NW TROOST ST",
            "address_2": "SUITE 103",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974716071",
            "telephone_number": "541-672-0497",
            "fax_number": "541-957-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED BLACK MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-30",
        "last_updated": "2011-11-21",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-672-0497",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD10476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "218557",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dawn Ann Fox, CADC I
• Frances C Munkenbeck MD PC
• Lois Francis-Wolf
• Myrsady Maye Franden, RPH, PHARM.D.
• Richard D Frank, NP
• Fred Meyer Stores Inc
• Aric Fromdahl
• Jennifer Ann Frost, DNP-FNP
• Alyssa Fujiuchi
• Nancy Marie Fuller, NP

• Family Medicine Physician in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.