Provider Demographics
NPI:1457324352
Name:BLACK, DAVID CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CHRISTOPHER
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3686 GRANDVIEW PKWY STE 820
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3408
Mailing Address - Country:US
Mailing Address - Phone:205-971-3000
Mailing Address - Fax:205-971-4910
Practice Address - Street 1:3686 GRANDVIEW PKWY STE 820
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3408
Practice Address - Country:US
Practice Address - Phone:205-971-3000
Practice Address - Fax:205-971-4910
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00012786207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-42889OtherBCBS
AL102I118432Medicare PIN
AL511-42889OtherBCBS