Individual provider · Type 1 NPI

Lance Michael Black, MD

Student in an Organized Health Care Education/Training Program · Eglin Afb, FL

NPI number 1508957325 Active

Practice location

307 Boatner Rd, Suite 114
Eglin Afb, FL 32542-1391

Call (850) 883-9624 Map

Mailing address

997 John Wayne Cir
Fort Walton Beach, FL 32547-4282

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1508957325

Lance Michael Black, MD's National Provider Identifier is 1508957325, issued on Sep 27, 2006. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Eglin Afb, FL. The record was last updated on Jul 8, 2007.