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Individual

DR. RANDALL A BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
1512 12TH AVE RD, ANESTHESIOLOGY CONSULTANTS OF IDAHO, NAMPA, ID 83686-6008
(208) 571-9043
Mailing address
1512 12TH AVE RD, NAMPA, ID 83686-6008
(208) 463-5029

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
O-0445
ID

Other

Enumeration date
07/20/2006
Last updated
01/17/2008
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