person
Matthew Wade Black, PA
Medical Physician Assistant in Grangeville, Idaho
NPI 1891415063

Matthew Wade Black is a Medical Physician Assistant based in Grangeville, ID and is specialized in Medical. Matthew Wade Black practices in Grangeville, ID and has the professional credentials of PA. The NPI Number for Matthew Wade Black is 1891415063 and holds a License No. PA-2620 (Idaho).

The current practice location address for Matthew Wade Black is 607 W Main St, Grangeville, ID and can be reached out via phone at 208-983-1700 and via fax at 208-983-4665.

Location: 607 W Main St, Grangeville, ID, 83530-1345
person
Provider Profile Details
NPI Number
1891415063
Provider Name
Matthew Wade Black
Credential
PA
Provider Entity Type
Individual
Gender
Male
Address
607 W Main St, Grangeville, ID, 83530-1345
Phone Number
208-983-1700
Fax Number
208-983-4665
Provider Enumeration Date
08/29/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
607 W Main St
City
State
Zip
83530-1345
Phone Number
208-983-1700
Fax Number
208-983-4665
person
Provider Business Mailing Address Details
Address
607 W Main St
City
State
Zip
83530-1345
Phone Number
208-983-1700
Fax Number
208-983-4665
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
PA-2620 (Idaho)
Definition
Definition to come...
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