Individual
KYLER BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
250 W 300 N, ROOSEVELT, UT 84066-2336
(435) 722-4691
Mailing address
250 W 300 N, ROOSEVELT, UT 84066-2336
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
12304561-1205
UT
208000000X
Pediatrics Physician
12304561-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2017
Last updated
07/28/2021
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