Individual
IAN CHARLES BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2776 CLEVELAND AVE, FORT MYERS, FL 33901
(239) 343-2606
(239) 343-3695
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-2606
(239) 343-3695
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-10430
NC
363A00000X
Physician Assistant
PA9110602
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022370000
—
FL
Enumeration date
09/26/2017
Last updated
11/13/2024
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