Individual
JEFFREY B BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7205 265TH ST NW, STANWOOD, WA 98292-6221
(360) 629-1505
(360) 629-1513
Mailing address
PO BOX 5127, EVERETT, WA 98206-5127
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33020
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1012719
—
WA
Enumeration date
03/09/2006
Last updated
12/09/2016
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