Individual
MISS FARRAH L BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1300 N 12TH ST, STE 500, PHOENIX, AZ 85006-2848
(602) 839-2606
(602) 839-4123
Mailing address
1300 N 12TH ST, STE 500, PHOENIX, AZ 85006-2848
(602) 839-2606
(602) 839-4123
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2874
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
803305
—
AZ
Enumeration date
01/06/2006
Last updated
10/02/2012
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