Individual
DR. BRENT DALE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
317 S 450 W UNIT D, SPRINGVILLE, UT 84663-5838
(435) 830-3772
Mailing address
317 S 450 W UNIT D, SPRINGVILLE, UT 84663-5838
(435) 830-3772
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
170138-1205
UT
2083X0100X
Occupational Medicine Physician
170138-1205
UT
Other
Enumeration date
06/11/2005
Last updated
02/27/2024
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