Individual
DEREK JOHN BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
475 W 1465 N APT 103, LOGAN, UT 84341-6619
(435) 851-3813
Mailing address
475 W 1465 N APT 103, LOGAN, UT 84341-6619
(435) 851-3873
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/01/2021
Last updated
12/01/2021
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