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General NPI Number Information
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NPI Number | 1619024544
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Entity Type | Individual
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Provider Name | RYAN DUANE BLACK D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 469 HIGHWAY 50
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City | GILLETTE
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State | WY
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Zip | 82718-9330
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Country | US
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Telephone | 307-387-9850
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Fax | 307-387-9890
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Provider Business Mailing Address
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Address Line | 201 W LAKEWAY RD STE 1004
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City | GILLETTE
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State | WY
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Zip | 82718-6349
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Country | US
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Telephone | 307-387-9850
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Fax | 307-387-9890
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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 | 207YX0602X
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Taxonomy Name | Otolaryngic Allergy Physician
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License Number | 14427A
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 14427A
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License Number State | WY
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