Individual provider · Type 1 NPI

Matthew Wade Black, PA

Medical Physician Assistant · Grangeville, ID

NPI number 1891415063 Active

Practice location

607 W Main St
Grangeville, ID 83530-1345

Call (208) 983-1700 Map

Fax (208) 983-4665

Other practice locations

  • 22 N Main St, Kooskia, ID 83539 · (208) 926-4776

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XPA-2620 (ID)

Medical Physician Assistant: Definition to come...

28 other providers at this address

Other medical physician assistant providers in Grangeville

See all in Grangeville →

About NPI 1891415063

Matthew Wade Black, PA's National Provider Identifier is 1891415063, issued on Aug 29, 2022. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Grangeville, ID. The record was last updated on Oct 25, 2023.