Black, Carl M

Black, Carl M is an individual health care provider with primary practice located at 1034 N 500 W , Provo UT 84604-3380. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Nuclear Radiology, Allopathic & Osteopathic Physicians / Diagnostic Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Black, Carl M can be contacted via phone (801) 373-7850.

Contact Information

Primary practice address
1034 N 500 W Provo UT 84604-3380
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nuclear Radiology 2085N0904X 4737479-1205 Utah
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 4737479-1205 Utah

Profile Details

NPI number 1891737094
LBN Legal business name Black, Carl M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 12th, 2006
Last updated Oct 22nd, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891737094 NPPES
Utah Other 870284448CB1 EMIA
Utah Other 47374791204001 EMIA
Utah Other 666798 EMIA
Utah Other 107008883101 EMIA

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