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Individual

DANIEL R. BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
100 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5401
(740) 446-5408
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5401
(740) 446-5408

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
34-00-4704
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000006573
ANTHEM BCBS
01
000000185253
UNISON MEDICAID
OH
01
001714051
MOUNTAIN STATE BCBS
05
0113223000
WV
01
0749373
MOLINA MEDICAID
OH
05
0749373
OH
01
200013580
RR MEDICARE
01
310917085122
CARESOURCE MEDICAID
OH
Enumeration date
05/20/2006
Last updated
02/26/2025
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