Individual
RICHARD E BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-2950
Mailing address
PO BOX 413035, SALT LAKE CITY, UT 84141-3035
(801) 213-3900
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
1597211205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05415
—
UT
Enumeration date
10/18/2006
Last updated
12/03/2013
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