Provider Demographics
NPI:1649201005
Name:BLACK, FRANK DUGGER (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:DUGGER
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 1:5366 LAVA LANE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-3042
Mailing Address - Country:US
Mailing Address - Phone:317-782-0111
Mailing Address - Fax:
Practice Address - Street 1:150 W WASHINGTON ST
Practice Address - Street 2:MAJOR HOSPITAL
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176
Practice Address - Country:US
Practice Address - Phone:317-398-5275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22678207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INBB5105766OtherBNDD
IN01022678DOtherCDS CERT
IN200164090Medicaid
IN01022678DOtherCDS CERT
INBB5105766OtherBNDD