MEDICARE: DR. JONATHAN BLACK MD, MPH

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	207VX0201X	Gynecologic Oncology Physician	ME132355	FL

General Provider Information

NPI Number	:	1700106184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN BLACK MD, MPH

Provider Business Mailing Address
First Line	:	12741 MIRAMAR PKWY STE 302
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-2905
Country	:	US
Telephone Number	:	954-602-9723
Fax Number	:	203-688-5599

Provider Business Practice Location Address
First Line	:	12741 MIRAMAR PKWY STE 302
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-2905
Country	:	US
Telephone Number	:	954-602-9723
Fax Number	:	203-688-5599

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

Provider Enumeration Date	:	06/08/2010
Last Update Date	:	07/30/2021

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