Individual
MARSHALL R BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
823 16TH AVE, LEWISTON, ID 83501-3733
(208) 798-0200
(208) 798-0201
Mailing address
823 16TH AVE, LEWISTON, ID 83501-3733
(208) 798-0200
(208) 798-0201
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
224P00000X
Prosthetist
—
—
Other
Enumeration date
06/23/2006
Last updated
11/02/2007
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