| Entity Name: | ALAN WAYNE BLACK, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 10 Sep 1985 (39 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | H75209 |
| FEI/EIN Number | 59-2583663 |
| Address: | 5800 COLONIAL DRIVE, SUITE 308, MARGATE, FL 33063 |
| Mail Address: | 5800 COLONIAL DRIVE, SUITE 308, MARGATE, FL 33063 |
| ZIP code: | 33063 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164737433 | 2010-08-11 | 2010-08-11 | 5800 COLONIAL DR STE 308, MARGATE, FL, 330635663, US | 5800 COLONIAL DR STE 308, MARGATE, FL, 330635663, US | |||||||||||||
|
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| Phone | +1 954-968-5000 |
Authorized person
| Name | DR. ALAN WAYNE BLACK |
| Role | PHYSICIAN- PRESIDENT |
| Phone | 9549685000 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BAROUH, RICHARD CPA | Agent | 10800 NW 5TH ST, PLANTATION, FL 33324 |
| Name | Role | Address |
|---|---|---|
| BLACK, ALAN WAYNE | Director | 5800 COLONIAL DRIVE, SUITE 308 MARGATE, FL 33063 |
| Name | Role | Address |
|---|---|---|
| BLACK, ALAN WAYNE | President | 5800 COLONIAL DRIVE, SUITE 308 MARGATE, FL 33063 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-01-10 | 10800 NW 5TH ST, PLANTATION, FL 33324 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-01-05 | 5800 COLONIAL DRIVE, SUITE 308, MARGATE, FL 33063 | No data |
| CHANGE OF MAILING ADDRESS | 2009-01-05 | 5800 COLONIAL DRIVE, SUITE 308, MARGATE, FL 33063 | No data |
| REGISTERED AGENT NAME CHANGED | 2005-01-10 | BAROUH, RICHARD CPA | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-01-30 |
| ANNUAL REPORT | 2016-01-10 |
| ANNUAL REPORT | 2015-03-06 |
| ANNUAL REPORT | 2014-01-15 |
| ANNUAL REPORT | 2013-01-09 |
| ANNUAL REPORT | 2012-01-13 |
| ANNUAL REPORT | 2011-01-05 |
| ANNUAL REPORT | 2010-01-10 |
| ANNUAL REPORT | 2009-01-05 |
| ANNUAL REPORT | 2008-01-25 |
Date of last update: 04 Feb 2025
Sources: Florida Department of State
