OrganizationActive
Charles L. Black Jr MD Surgical Clinic Corp
NPI 1952442832 · Surgery Physician · Shreveport, LA
Provider details
- NPI number
- 1952442832
- Entity type
- Organization
- Primary specialty
- Surgery PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Charles Black, Owner(318) 221-0166
- License
- 011576 (LA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
1534 Elizabeth Ave
Suite 202
Shreveport, LA 71101-4516
Phone: (318) 221-0166
Approximate (ZIP-level) locationGet directions
Mailing address
1534 Elizabeth Ave
Shreveport, LA 71101-4516
Registry dates
- Enumerated
- 2007-02-12
- Last updated
- 2007-09-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.