Provider Demographics
NPI:1053722413
Name:BLACK, WILLIAM CONRAD (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CONRAD
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 GRANDVIEW PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3411
Mailing Address - Country:US
Mailing Address - Phone:205-971-7500
Mailing Address - Fax:205-971-7572
Practice Address - Street 1:3680 GRANDVIEW PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3411
Practice Address - Country:US
Practice Address - Phone:205-971-7500
Practice Address - Fax:205-971-7572
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL34489207RC0000X, 207RI0011X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program