Provider Demographics
NPI:1700106184
Name:BLACK, JONATHAN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12741 MIRAMAR PKWY STE 302
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2905
Mailing Address - Country:US
Mailing Address - Phone:954-602-9723
Mailing Address - Fax:203-688-5599
Practice Address - Street 1:12741 MIRAMAR PKWY STE 302
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2905
Practice Address - Country:US
Practice Address - Phone:954-602-9723
Practice Address - Fax:203-688-5599
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME132355207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology