Black, Judy

Black, Judy is an sole proprietor health care provider with primary practice located at 495 Sw Ramsey Ave , Grants Pass OR 97527-5681. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Independent Medical Examiner, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is her primary health care specialty. Black, Judy can be contacted via phone (541) 476-6644.

Contact Information

Primary practice address
495 Sw Ramsey Ave Grants Pass OR 97527-5681
Phone: (541) 476-6644
Fax: (541) 472-5673
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Independent Medical Examiner 202C00000X 036113715 Illinois
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD 170104 Oregon
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD170104 Oregon
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 036113715 Illinois

Profile Details

NPI number 1770786667
LBN Legal business name Black, Judy
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 7th, 2007
Last updated Jul 18th, 2024 - about last year

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 1770786667 NPPES
Illinois MEDICAID 036113715
Illinois MEDICAID 500680833

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