Provider Demographics
NPI:1679689335
Name:BLACK, STUART BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:BARRY
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7515 GREENVILLE AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3831
Mailing Address - Country:US
Mailing Address - Phone:214-345-1299
Mailing Address - Fax:214-345-1297
Practice Address - Street 1:7515 GREENVILLE AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3831
Practice Address - Country:US
Practice Address - Phone:214-345-1299
Practice Address - Fax:214-345-1297
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD90832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80A122Medicare PIN
TXC13488Medicare UPIN
TX8516M3Medicare ID - Type UnspecifiedMEDICARE