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Individual
VICKI L BLACK
Active
Individual
VICKI L BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00015749
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039695
LABOR & INDUSTRIES
WA
05
—
1034487
—
WA
01
—
8931362
CRIME VICTIMS
WA
01
—
P000050810
RAILROAD MEDICARE
WA
Enumeration date
07/18/2005
Last updated
05/16/2013
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