DESTIN R. BLACK


Address: 2600 Kings Hwy, Suite 420, Shreveport, LA 71103-3950
Phone: 3182128727

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207VX0201X Obstetrics & Gynecology
Specialization: Gynecologic Oncology
024725 LA Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
LA MEDICARE - PTAN 4K574F600 01
LA 1577936 05

Office Location

Street Address 2600 KINGS HWY
SUITE 420
City SHREVEPORT
State LA
Zip Code 71103-3950

Providers in the same location

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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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 207VX0201X
Grouping Allopathic & Osteopathic Physicians
Classification Obstetrics & Gynecology
Specialization Gynecologic Oncology

Taxonomy Definition

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.

Providers in the same taxonomy and city

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

Providers in the same taxonomy and state

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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Competitor

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City SHREVEPORT
Zip Code 71103

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Dataset Information

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.

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