Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MATTHEW WADE BLACK, PA
ActiveMedical Physician Assistant · GRANGEVILLE, ID
Registration Details
- NPI Number
- 1891415063
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Aug 29, 2022 (3.6444496681804 yrs)
- Last Updated
- Oct 25, 2023
- License
-
PA-2620 (ID)
Practice Information
- Address
-
607 W MAIN STGRANGEVILLE, ID, 835301345Browse ID providers · Browse ZIP 83530
- Phone
- 2089831700
- Fax
- 2089834665
- Primary Specialty
-
Medical Physician Assistant
363AM0700X
Other Medical Physician Assistant Providers in GRANGEVILLE, ID
| Name | Credential | NPI |
|---|---|---|
| MR. DEREK R WYNN | PA | 1043689441 |
| BRADI MOREL VOIGT TRAPP | PA-C | 1538046339 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.