Individual
KATHERYN K BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016
(602) 263-1200
Mailing address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1200
(785) 628-3650
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
007526
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100232560C
—
KS
Enumeration date
05/03/2006
Last updated
05/31/2018
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