Individual
JEREMY TAYLOR BLACK I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6517 CEDAR BEND CT, MOBILE, AL 36608-5333
(801) 842-1517
Mailing address
6517 CEDAR BEND CT, MOBILE, AL 36608-5333
(801) 842-1517
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA223011
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/09/2023
Last updated
12/17/2024
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