Provider Demographics
NPI:1508045352
Name:JAMES A. BLACK, M.D.
Entity Type:Organization
Organization Name:JAMES A. BLACK, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-707-8100
Mailing Address - Street 1:4007 JAMES CASEY ST
Mailing Address - Street 2:SUITE C110
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3369
Mailing Address - Country:US
Mailing Address - Phone:512-707-8100
Mailing Address - Fax:512-707-8101
Practice Address - Street 1:4007 JAMES CASEY ST
Practice Address - Street 2:SUITE C110
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3369
Practice Address - Country:US
Practice Address - Phone:512-707-8100
Practice Address - Fax:512-707-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD99462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0010PAOtherBCBS
TX0010PAOtherBCBS
TX612690Medicare PIN