Individual provider · Type 1 NPI

Trevor Elan Black, D.P.M.

Foot & Ankle Surgery Podiatrist · Moscow, ID

NPI number 1861835308 Active

Practice location

623 S Main St Ste 1
Moscow, ID 83843-3042

Call (208) 882-2011 Map

Mailing address

PO Box 8007
Moscow, ID 83843-0507

Other practice locations

  • 20 Glenlake Pkwy, Kaiser Permanente Glenlake Medical Center, Atlanta, GA 30328-3473 · (818) 326-1058
  • 700 S Main St, Moscow, ID 83843-3046 · (208) 882-4511

Specialties and licenses

TaxonomyCodeLicense
Foot & Ankle Surgery Podiatrist Primary 213ES0103X3381305 (ID)
Student in an Organized Health Care Education/Training Program 390200000XNone listed
Foot & Ankle Surgery Podiatrist 213ES0103XPOD001289 (GA)

Foot & Ankle Surgery Podiatrist: Definition to come...

11 other providers at this address

About NPI 1861835308

Trevor Elan Black, D.P.M.'s National Provider Identifier is 1861835308, issued on Apr 15, 2013. The primary taxonomy on file is Foot & Ankle Surgery Podiatrist (213ES0103X), and the practice location is in Moscow, ID. The record was last updated on Sep 22, 2026.