FRED BLACK MD PC
Marriage and Family Therapists at Troost St, Roseburg, OR

License number
Oregon MD10476
Category
Osteopathic Medicine
Type
Family Medicine
Owner
Name: FREDERICK J BLACK MD
Title: PRESIDENT
Phone: (541) 672-0497
Address
Address
2282 NW Troost St SUITE 103, Roseburg, OR 97471
National Provider ID: 1710970330
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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FRED BLACK, M.D., PC

Roseburg, OR

Registration:
Jan 21, 2000
Addresses:
11 Ridgewood Dr, Roseburg, OR 97471 (Physical)
425 SE Jackson St, Roseburg, OR 97470 (Mailing)
State ID:
73165186
Business type:
DOMESTIC PROFESSIONAL CORPORATION
Agent:
Derek Dsimmons,425 SE Jackson St, Roseburg, OR 97470 (Physical)

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