Individual
JOSEPH BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3311 E MURDOCK ST, WICHITA, KS 67208-3054
(316) 689-9325
(316) 689-9374
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135
(316) 689-9102
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
00762
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110716
BCBS
KS
Enumeration date
08/06/2006
Last updated
07/16/2007
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