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General NPI Number Information
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NPI Number | 1770786667
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Entity Type | Individual
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Provider Name | JUDY BLACK M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 1937 W HARVARD AVE
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City | ROSEBURG
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State | OR
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Zip | 97471-2720
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Country | US
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Telephone | 541-677-7200
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Fax | 541-229-3309
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Provider Business Mailing Address
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Address Line | 2570 NW EDENBOWER BLVD STE 100
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City | ROSEBURG
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State | OR
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Zip | 97471-6214
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Country | US
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Telephone | 541-677-7200
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Fax | 541-229-3309
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD 170104
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 202C00000X
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Taxonomy Name | Independent Medical Examiner Physician
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License Number | 036113715
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD170104
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036113715
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License Number State | IL
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