Dr Evan G Black LLC

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

187597-1205 Issued in UT

Legal business name

DR EVAN G BLACK LLC

Practice address

5323 Woodrow St # 120W
Suite 201
Murray, UT 84107-5841

Phone

(801) 261-4711

Fax

(801) 261-4769

NPI assigned

Feb 11, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Dawson

Title

Clinic Manager

Phone

(801) 408-5702

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Rocky Mountain Neurology Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Diana D. Banks, M.D.

  • Neurology Physician
  • Salt Lake City, UT
  • NPI 1174543060
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234396800000",
    "number": "1902074115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95970",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840950970",
            "telephone_number": "801-352-9500",
            "fax_number": "801-352-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5323 WOODROW ST # 120W",
            "address_2": "SUITE 201",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075841",
            "telephone_number": "801-261-4711",
            "fax_number": "801-261-4769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR EVAN G BLACK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-11",
        "last_updated": "2009-02-12",
        "status": "A",
        "authorized_official_last_name": "DAWSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "801-408-5702"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": "UT",
            "license": "187597-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILRAOD MEDICARE",
            "identifier": "130012929",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902074115",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rocky Mountain Neurology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Curtis Downing, ACMHC
• Phillip Downing, MPAS, P.A.-C.
• Randy N. Downing, DDS
• Brenda Joyce Dowse, LCSW
• Lisa Doyle, MD
• Dr. Ari Hobfoll, DMD PC
• Debra Drabner
• Dragonfly Child and Family Counseling Services
• Benjamin Philip Draleau, PA-C
• Wilford J. Dredge, L.C.S.W.

• Neurological Surgery Physician in Murray, UT
• Providers in Murray, UT by specialty
• Neurological Surgery Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.