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1265460406

NPI Code Detail

MEDICARE: PETER K BLACK MD

MEDICARE: PETER K BLACK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD61439872	WA
2	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	MD24481	OR
3	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	MD61439872	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00464800	OTHER	OR	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265460406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER K BLACK MD

Provider Business Mailing Address
First Line	:	8716 E MILL PLAIN BLVD
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-2531
Country	:	US
Telephone Number	:	360-514-4325
Fax Number	:

Provider Business Practice Location Address
First Line	:	8716 E MILL PLAIN BLVD
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-2531
Country	:	US
Telephone Number	:	360-514-4325
Fax Number	:	360-514-4336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	06/26/2025

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Directions to “ PETER K BLACK MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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