Individual
DR. JASON BRUCE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
801 OSTRUM ST, BETHLEHEM, PA 18015-1000
(814) 806-8450
Mailing address
1070 HILL DR, ALLENTOWN, PA 18103-6140
(814) 806-8450
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
007628
AZ
207P00000X
Emergency Medicine Physician
OS017853
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
411971
—
AZ
Enumeration date
06/04/2014
Last updated
06/28/2021
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