Provider Demographics
NPI:1235228636
Name:BLACK, STEVEN EARL (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:EARL
Last Name:BLACK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:44444 16TH ST W
Mailing Address - Street 2:103
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2840
Mailing Address - Country:US
Mailing Address - Phone:661-940-8888
Mailing Address - Fax:661-940-8828
Practice Address - Street 1:44404 16TH ST W STE 205
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2839
Practice Address - Country:US
Practice Address - Phone:661-940-8888
Practice Address - Fax:661-940-8828
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2158213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE2158OtherBLUE CROSS
CAE2158Medicare ID - Type Unspecified