Black, Jason Bruce

Black, Jason Bruce is an individual health care provider with primary practice located at 801 Ostrum St , Bethlehem PA 18015-1000. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Black, Jason Bruce can be contacted via phone (814) 806-8450.

Contact Information

Primary practice address
801 Ostrum St Bethlehem PA 18015-1000
Phone: (814) 806-8450
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X OS017853 Pennsylvania
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 007628 Arizona

Profile Details

NPI number 1982017232
LBN Legal business name Black, Jason Bruce
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 4th, 2014
Last updated Jun 28th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982017232 NPPES
Arizona MEDICAID 411971

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