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:
Health care specialties
| Specialty | Code | License # | 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 4 months 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1770786667 | NPPES |
| Illinois | MEDICAID | 036113715 | |
| Illinois | MEDICAID | 500680833 |
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