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General NPI Number Information
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NPI Number | 1972008373
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Entity Type | Individual
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Provider Name | LOREN ORION BLACK MD MBA
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Gender | Male
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 6165 W EMERALD ST
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City | BOISE
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State | ID
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Zip | 83704-8613
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Country | US
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Telephone | 208-302-3900
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Fax | 208-302-3955
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Provider Business Mailing Address
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Address Line | PO BOX 190930
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City | BOISE
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State | ID
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Zip | 83719-0930
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD61416009
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | MD61416009
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | M-17771
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License Number State | ID
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