Matthew Wade Black, PA
NPI #1891415063 in Grangeville, Idaho
Provider Information
- NPI Number
- 1891415063
- Entity Type
- Individual
- Name
- Matthew Wade Black, PA
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Physician Assistant - Medical
- Credential
- PA
- Enumeration Date
- Aug 29, 2022
- Last Updated
- Oct 25, 2023
Practice Location
- Address
- 607 W MAIN ST
- City
- Grangeville
- State
- Idaho
- ZIP Code
- 83530-1345
- Phone
- (208) 983-1700
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physician Assistant - Medical — Medical |
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