DESTIN R. BLACK (NPI# 1306062625) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1306062625 |
Entity Type | Individual |
Full Name | DESTIN R. BLACK |
Credential | MD |
Practice Address |
2600 Kings Hwy Suite 420 Shreveport LA 71103-3950 |
Practice Telephone | 3182128727 |
Practice Fax Number | 3182128771 |
Mailing Telephone | 3182128727 |
Mailing Fax Number | 3182128771 |
Enumeration Date | 2007-04-17 |
Last Update Date | 2016-07-28 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207VX0201X |
Obstetrics & Gynecology Specialization: Gynecologic Oncology |
024725 | LA | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
LA | MEDICARE - PTAN | 4K574F600 | 01 |
LA | 1577936 | 05 |
Street Address |
2600 KINGS HWY SUITE 420 |
City | SHREVEPORT |
State | LA |
Zip Code | 71103-3950 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1265439863 | Michael Leonard Durci | Radiology | 2600 Kings Hwy, Willis Knighton Cancer Center, Shreveport, LA 71103-3950 | 2005-06-28 |
1922478304 | Wk Radiation Oncology Services | Radiology | 2600 Kings Hwy, Shreveport, LA 71103-3950 | 2015-09-29 |
1932578820 | Amanda Lyn Hayes | Nurse Practitioner | 2600 Kings Hwy, #420, Shreveport, LA 71103-3950 | 2015-09-21 |
1659767127 | Sergio Jaramillo | Radiology | 2600 Kings Hwy, Shreveport, LA 71103-3950 | 2015-04-11 |
1457615395 | Chiachien Jake Wang | Radiology | 2600 Kings Hwy, Shreveport, LA 71103-3950 | 2012-06-26 |
1528330305 | Andrea Marie Moore | Clinical Nurse Specialist | 2600 Kings Hwy, Suite 340, Shreveport, LA 71103-3950 | 2012-02-08 |
1093006603 | Daniella Phuong-di Dang | Radiology | 2600 Kings Hwy, Shreveport, LA 71103-3950 | 2011-04-29 |
1548448442 | Robin Ann Lacour | Obstetrics & Gynecology | 2600 Kings Hwy, Suite 420, Shreveport, LA 71103-3950 | 2008-02-04 |
1740493923 | Wk Gynecologic Oncology Clinic | Obstetrics & Gynecology | 2600 Kings Hwy, Suite 420, Shreveport, LA 71103-3950 | 2007-05-07 |
1447475603 | David Bruce Carrington | Pharmacist | 2600 Kings Hwy, Suite 212, Shreveport, LA 71103-3950 | 2007-04-14 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1083124887 | Elizabeth Ponder | Case Manager/Care Coordinator | 404 Hearne Avenue, Shreveport, LA 71103 | 2017-10-05 |
1245648393 | Madiha Tariq | General Acute Care Hospital | Rheumatology Clinic, 1501 Kings Hwy, Sheveport, LA 71103 | 2014-07-31 |
1659782688 | Jennifer G Smith | Pharmacist | 1725 Claiborne Ave, Shreveport, LA 71103 | 2014-05-13 |
1336568823 | Taylor Jieun Jung | Student in an Organized Health Care Education/Training Program | Lsu Health Sciences Center 1501 Kings Highway, Department of Oral & Maxillofacial Surgery Room 530, Shreveport, LA 71103 | 2014-04-10 |
1578984746 | Jamie Terrell | Pharmacist | 1625 Claiborne Ave, Shreveport, LA 71103 | 2013-12-13 |
1346675188 | Srijan Tandukar | Internal Medicine | 2751 Albert L Bicknell Dr Ste 2b, Shreveport, LA 71103 | 2013-09-12 |
1699017681 | Deanna Elise Mossallati | Internal Medicine | 8551 Greenwood Rd, Suite 410, Shreveport, LA 71103 | 2013-03-18 |
1346527330 | Tim M Smith | Clinical Exercise Physiologist | 3200 Greenwood Rd., Shreveport, LA 71103 | 2011-11-04 |
1144451683 | Second Chance Recovery | Durable Medical Equipment & Medical Supplies | 3816 Linwood, Shreveport, LA 71103 | 2009-07-31 |
1093919920 | Neeraj Singh | Internal Medicine | 2751 Albert L Bicknell Dr Fl 4, Shreveport, LA 71103 | 2007-06-13 |
Find all providers in zip 71103 |
Taxonomy Code | 207VX0201X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Obstetrics & Gynecology |
Specialization | Gynecologic Oncology |
An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1548448442 | Robin Ann Lacour | Obstetrics & Gynecology | 2600 Kings Hwy, Suite 420, Shreveport, LA 71103-3950 | 2008-02-04 |
1740493923 | Wk Gynecologic Oncology Clinic | Obstetrics & Gynecology | 2600 Kings Hwy, Suite 420, Shreveport, LA 71103-3950 | 2007-05-07 |
1427179845 | Antonio R. Pizarro, Md, Apmc | Obstetrics & Gynecology | 1801 Fairfield Ave, Suite 207, Shreveport, LA 71101-4443 | 2007-04-03 |
1861572349 | Ricky Lawayne Owers | Obstetrics & Gynecology | 1455 E Bert Kouns Loop, #300, Shreveport, LA 71105-5634 | 2006-10-17 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1952692048 | Navya Nair | Obstetrics & Gynecology | 1542 Tulane Ave Dept Of, New Orleans, LA 70112 | 2011-04-25 |
1457316283 | Patricia S Braly | Obstetrics & Gynecology | 606 West 12th Street, Covington, LA 70433 | 2006-04-17 |
1861460297 | Milton Giles Fort | Obstetrics & Gynecology | 500 Rue De La Vie St Ste 410, Baton Rouge, LA 70817-5128 | 2006-03-10 |
1386083178 | Woman's Gynecologic Oncology | Obstetrics & Gynecology | 500 Rue De La Vie St, Suite 311, Baton Rouge, LA 70817-5127 | 2013-06-14 |
1881962520 | Baton Rouge General Medical Center | Obstetrics & Gynecology | 8595 Picardy Ave, Suite 300, Baton Rouge, LA 70809-3670 | 2011-12-08 |
1992965834 | Katrina Slaughter Wade | Obstetrics & Gynecology | 1514 Jefferson Hwy, New Orleans, LA 70121-2429 | 2008-06-13 |
1619137924 | Jacob M. Estes, M.d., LLC | Obstetrics & Gynecology | 9000 Airline Hwy, Ste 210, Baton Rouge, LA 70815-4114 | 2008-06-10 |
1346445459 | Hematology & Oncology Specialists LLC | Obstetrics & Gynecology | 39 Starbrush Cir, Covington, LA 70433-7209 | 2007-06-19 |
1982767810 | Jessica J Shank | Obstetrics & Gynecology | 150 S Liberty St, New Orleans, LA 70112 | 2006-12-19 |
1568554319 | Pui Cheng | Obstetrics & Gynecology | 3434 Prytania St, Suite 320, New Orleans, LA 70115-3532 | 2006-09-29 |
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City | SHREVEPORT |
Zip Code | 71103 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.