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General NPI Number Information
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NPI Number | 1578556833
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Entity Type | Individual
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Provider Name | ELIZABETH LEFFT BLACK MD
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Gender | Female
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 1271 HIGHLAND AVE STE B
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City | CLARKSTON
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State | WA
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Zip | 99403-2846
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Country | US
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Telephone | 509-751-5500
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Fax | 509-751-1059
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Provider Business Mailing Address
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Address Line | 1271 HIGHLAND AVE STE B
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City | CLARKSTON
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State | WA
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Zip | 99403-2846
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Country | US
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Telephone | 509-751-5500
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Fax | 509-751-1059
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M9634
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00045393
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License Number State | WA
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