CARL M BLACK

PROVO, UT
NPI1891737094
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2085R0202X Radiology Diagnostic Radiology
(Licence: UT  4737479-1205)
Additional Taxonomies2085N0904X Radiology Nuclear Radiology
(Licence: UT  4737479-1205)
Enumeration Date2006-06-12
Last Update Date2015-10-22
Business Address
CARL M BLACK MD
1034 N 500 W
PROVO, UT 84604-3380
Phone number: 801-373-7850
Mailing Address
CARL M BLACK MD
560W 800 N
OREM, UT 84057-3746
Phone number: 801-225-6246