Black, Richard E
Black, Richard E is an individual health care provider with primary practice located at 100 Mario Capecchi Dr , Salt Lake City UT 84113-1103. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Surgery, which is considered as his primary health care specialty. Black, Richard E can be contacted via phone (801) 662-2950.Contact Information
Primary practice address
100 Mario Capecchi Dr
Salt Lake City UT 84113-1103
Phone: (801) 662-2950
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatric Surgery | 2086S0120X | 1597211205 | Utah |
Profile Details
| NPI number | 1316028103 |
|---|---|
| LBN Legal business name | Black, Richard E |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 18th, 2006 |
| Last updated | Dec 3rd, 2013 - about 11 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316028103 | NPPES |
| Utah | MEDICAID | 05415 |
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