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General NPI Number Information
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NPI Number | 1134110109
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Entity Type | Individual
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Provider Name | IAN H BLACK MD
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 400 W 16TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-2745
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Country | US
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Telephone | 719-584-4045
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 16TH ST
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City | GREELEY
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State | CO
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Zip | 80631-5154
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | DR.0065589
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 01053867A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 042-0011556
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License Number State | VT
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Taxonomy #4
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | 042-0011556
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License Number State | VT
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Taxonomy #5
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 042-0011556
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License Number State | VT
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