Organization
DR EVAN G BLACK LLC
Active
Other names
Rocky Mountain Neurology
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER DAWSON (CLINIC MANAGER)
(801) 408-5702
Entity
Organization
Contact information
Practice address
5323 WOODROW ST # 120W, SUITE 201, MURRAY, UT 84107-5841
(801) 261-4711
(801) 261-4769
Mailing address
PO BOX 95970, SOUTH JORDAN, UT 84095-0970
(801) 352-9500
(801) 352-9502
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
187597-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130012929
RAILRAOD MEDICARE
UT
05
—
1902074115
—
UT
Enumeration date
02/11/2008
Last updated
02/12/2009
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