Individual
JUDY BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1937 W HARVARD AVE, ROSEBURG, OR 97471-2720
(541) 677-7200
(541) 229-3309
Mailing address
2570 NW EDENBOWER BLVD STE 100, ROSEBURG, OR 97471-6214
(541) 677-7200
(541) 229-3309
Taxonomy
Speciality
Code
Description
License number
State
202C00000X
Independent Medical Examiner Physician
036113715
IL
208000000X
Pediatrics Physician
036113715
IL
208000000X
Pediatrics Physician
Primary
MD 170104
OR
208000000X
Pediatrics Physician
MD170104
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113715
—
IL
05
—
500680833
—
OR
Enumeration date
06/07/2007
Last updated
08/07/2025
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