Individual
MR. DARRYLL W. BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
88 MDG, 4881 SUGAR MAPLE DR, WRIGHT-PATTERSON AFB, OH 45433-5529
(937) 257-6569
Mailing address
88 MDG, 4881 SUGAR MAPLE DR, WRIGHT-PATTERSON AFB, OH 45433-5529
(937) 257-6569
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002023A
IN
363AS0400X
Surgical Physician Assistant
MA053346
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0171202
—
OH
05
—
OPR
—
IN
Enumeration date
06/26/2008
Last updated
04/11/2018
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