Healthcare Provider Details

I. General information

NPI: 1518499268
Provider Name (Legal Business Name): KYLER BLACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 E RIVERSIDE DR STE 8
ST GEORGE UT
84790-5790
US

IV. Provider business mailing address

368 E RIVERSIDE DR STE 8
ST GEORGE UT
84790-5790
US

V. Phone/Fax

Practice location:
  • Phone: 435-313-4632
  • Fax: 866-388-1939
Mailing address:
  • Phone: 435-313-4632
  • Fax: 866-388-1939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12304561-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12304561-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: