Individual
DR. RICHARD R BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
28062 BAXTER RD, MURRIETA, CA 92563-1401
(951) 290-4000
Mailing address
PO BOX 89, CHAGRIN FALLS, OH 44022-0089
(216) 245-0203
(440) 893-9680
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
34003488
OH
207U00000X
Nuclear Medicine Physician
Primary
34003488
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019707330001
—
PA
05
—
0834262
—
OH
01
—
3312151 00
MEDICAID PTAN
MD
05
—
8470726
—
WA
01
—
BL4212094
MEDICARE PTAN
OH
Enumeration date
11/28/2005
Last updated
01/27/2023
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