Individual
DAN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 NE IRVING ST, 250, PORTLAND, OR 97232-2243
(503) 233-4356
Mailing address
1108 JEFFERSON ST, OREGON CITY, OR 97045-1673
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/12/2007
Last updated
12/12/2007
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