Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | E2158 | CA |
NPI | 1235228636 |
---|---|
Provider Name | Dr. Steven Earl Black |
First Address | Lancaster, CA 93534-2840 |
Second Address | Lancaster, CA 93534-2840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E2158 | BLUE CROSS (01) | CA |