Individual
MR. JOSHUA PHILLIP BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
740 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5285
(208) 542-9111
Mailing address
3784 E TERRACE HILLS LN, RIGBY, ID 83442-5328
(509) 770-0776
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-2447
ID
363AM0700X
Medical Physician Assistant
Primary
PA-2447
ID
Other
Enumeration date
01/30/2023
Last updated
01/30/2023
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