MEDICARE: WILLIAM BLACK M.D., PH.D.

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	G80669	CA

General Provider Information

NPI Number	:	1467532010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM BLACK M.D., PH.D.

Provider Business Mailing Address
First Line	:	2015 STEINER ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 STEINER ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2627
Country	:	US
Telephone Number	:	415-600-0140
Fax Number	:

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	01/03/2012

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