Individual
SCOTT BAYLES BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
51600 HUNTINGTON RD, LA PINE, OR 97739-8887
(541) 536-3435
Mailing address
PO BOX 3300, LA PINE, OR 97739-3300
(541) 536-3435
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
8699736-1205
UT
207Q00000X
Family Medicine Physician
Primary
MD171322
OR
Other
Enumeration date
05/16/2012
Last updated
07/28/2015
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