Individual
MR. COLLIN SHEFFIELD BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 ROSE ST, LEXINGTON, KY 40536-6136
(801) 471-9422
Mailing address
532 FOREST HILL DR, LEXINGTON, KY 40509-1912
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
R5445
KY
Other
Enumeration date
02/25/2020
Last updated
03/09/2023
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