Provider Demographics
NPI:1285653584
Name:BLACK, ALISON ADAMS (MD)
Entity Type:Individual
Prefix:MS
First Name:ALISON
Middle Name:ADAMS
Last Name:BLACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W LYNDON B JOHNSON FWY
Mailing Address - Street 2:365
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3707
Mailing Address - Country:US
Mailing Address - Phone:972-432-0300
Mailing Address - Fax:972-432-0874
Practice Address - Street 1:440 W LYNDON B JOHNSON FWY
Practice Address - Street 2:365
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3707
Practice Address - Country:US
Practice Address - Phone:972-432-0300
Practice Address - Fax:972-432-0874
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1878174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T26ZMedicare ID - Type Unspecified
TXG02731Medicare UPIN