Individual
BRANDON R BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1619 N GREENWOOD ST, SUITE 103, PUEBLO, CO 81003-2644
(719) 542-2167
(719) 542-0320
Mailing address
1619 N GREENWOOD ST, SUITE 103, PUEBLO, CO 81003-2644
(719) 542-2167
(719) 542-0320
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2001015984
MO
Other
Enumeration date
03/18/2006
Last updated
02/09/2008
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