Provider Demographics
NPI:1861495665
Name:BLACK, WILLIAM GEYMAN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GEYMAN
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:PO BOX 1908
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-1908
Mailing Address - Country:US
Mailing Address - Phone:985-542-0663
Mailing Address - Fax:985-542-7010
Practice Address - Street 1:15748 MEDICAL ARTS DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1446
Practice Address - Country:US
Practice Address - Phone:985-542-0663
Practice Address - Fax:985-542-7010
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL012623207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1187283Medicaid
LAB605836Medicare UPIN
LA5J725Medicare ID - Type Unspecified