Individual
ELIZABETH ASHLEY BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
305 E JEFFERSON ST, BOISE, ID 83712-6231
(208) 381-7336
(208) 381-7495
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8866
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
A151555
CA
2080B0002X
Pediatric Obesity Medicine Physician
A151555
CA
2080P0210X
Pediatric Nephrology Physician
Primary
2971396
ID
2080P0210X
Pediatric Nephrology Physician
A151555
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/28/2015
Last updated
06/03/2026
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