Individual
STUART BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
223 16TH AVE N, NAMPA, ID 83687-4058
(208) 466-7869
(208) 466-5359
Mailing address
PO BOX 9, NAMPA, ID 83653-0009
(208) 466-7869
(208) 466-5359
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01060962A
IN
207Q00000X
Family Medicine Physician
Primary
M-9850
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053351361
—
ID
01
—
11000131
MEDICARE PTAN
ID
01
—
11000132
MEDICARE PTAN
ID
01
—
11000133
MEDICARE PTAN
ID
01
—
M9850
IDAHO LICENSE
ID
01
—
P00777176
MEDICARE RAILROAD PTAN
ID
Enumeration date
06/07/2006
Last updated
05/27/2025
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