Individual
DR. BRIAN EDWARD BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1611 NW 12TH AVE, MIAMI, FL 33136-1005
(305) 585-5881
(305) 585-3322
Mailing address
1611 NW 12TH AVE, MIAMI, FL 33136-1005
(305) 585-5881
(305) 585-3322
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
31096
WI
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
ME138640
FL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
31096
WI
2080S0010X
Pediatric Sports Medicine Physician
31096
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31606600
—
WI
Enumeration date
10/14/2005
Last updated
06/15/2021
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