Provider Demographics
NPI:1811078975
Name:BLACK, JONATHAN D (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7300 SANDLAKE COMMONS BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8050
Mailing Address - Country:US
Mailing Address - Phone:407-248-8000
Mailing Address - Fax:
Practice Address - Street 1:7300 SANDLAKE COMMONS BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8050
Practice Address - Country:US
Practice Address - Phone:407-248-8000
Practice Address - Fax:407-248-8909
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2011-11-30
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Provider Licenses
StateLicense IDTaxonomies
FLME 92118207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03369AMedicare PIN