Provider Demographics
NPI:1922148584
Name:BLACK, DONALD R (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6490 S MCCARRAN BLVD
Mailing Address - Street 2:SUITE A3
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6102
Mailing Address - Country:US
Mailing Address - Phone:775-827-6000
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:6490 S MCCARRAN BLVD
Practice Address - Street 2:SUITE A3
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6102
Practice Address - Country:US
Practice Address - Phone:775-827-6000
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV5383207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVE47371Medicare UPIN