Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 31096 | WI |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME138640 | FL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 31096 | WI |
NPI | 1649269473 |
---|---|
Provider Name | Dr. Brian Edward Black |
First Address | Miami, FL 33136-1005 |
Second Address | Miami, FL 33136-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 15/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31606600 | (05) | WI |
E27519 | (02) |