Basic Information
| Provider Information | |||||||||
| NPI: | 1922148584 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLACK | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6490 S MCCARRAN BLVD | ||||||||
| Address2: | SUITE A3 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895096102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758276000 | ||||||||
| FaxNumber: | 0000000000 | ||||||||
| Practice Location | |||||||||
| Address1: | 6490 S MCCARRAN BLVD | ||||||||
| Address2: | SUITE A3 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895096102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758276000 | ||||||||
| FaxNumber: | 0000000000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 11/27/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 5383 | NV | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
No ID Information.