Provider Demographics
NPI:1235133679
Name:BLACK, DAVID L (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-5400
Mailing Address - Fax:417-347-5709
Practice Address - Street 1:3105 MCCLELLAND BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1640
Practice Address - Country:US
Practice Address - Phone:417-781-2807
Practice Address - Fax:417-781-3309
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2020-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0421272207X00000X
OK17973207X00000X
MOR3P27207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery