Individual
CHARLES BRAD BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
214 E 3RD ST, LIBBY, MT 59923-2056
(406) 293-9274
(406) 293-9280
Mailing address
214 E 3RD ST, LIBBY, MT 59923-2056
(406) 293-9274
(406) 293-9280
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4055
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00056940
—
MT
01
—
92298
BLUE CROSS BLUE SHIELD MT
MT
Enumeration date
12/28/2006
Last updated
11/18/2013
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