Healthcare Provider Details

I. General information

NPI: 1700916509
Provider Name (Legal Business Name): FRANKLIN OWEN BLACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: F OWEN BLACK MD

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 NE 2ND AVE SUITE 305
PORTLAND OR
97208
US

IV. Provider business mailing address

PO BOX 3950
PORTLAND OR
97208
US

V. Phone/Fax

Practice location:
  • Phone: 503-233-6068
  • Fax: 503-233-8558
Mailing address:
  • Phone: 503-233-6088
  • Fax: 503-233-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberMD13135
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: