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Individual

RYAN BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
703 RIGBY LAKE DR, RIGBY, ID 83442-5192
(208) 745-0200
(208) 745-0212
Mailing address
703 RIGBY LAKE DR, RIGBY, ID 83442-5192
(208) 745-0200
(208) 745-0212

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TX

Other

Enumeration date
10/25/2012
Last updated
10/24/2023
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