Individual
MICHAEL R BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
98 STATE ST, PROCTORVILLE, OH 45669-8163
(740) 886-9403
(740) 446-5153
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 441-5749
(740) 446-5153
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35098736
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0067640
—
OH
05
—
3810023380
—
WV
Enumeration date
06/23/2009
Last updated
11/25/2020
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