Provider Demographics
NPI:1427492354
Name:BLACK, RYAN DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DANIEL
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 ADAMS ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3709
Mailing Address - Country:US
Mailing Address - Phone:256-536-9020
Mailing Address - Fax:256-536-9053
Practice Address - Street 1:825 ADAMS ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-536-9020
Practice Address - Fax:256-536-9053
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL37015208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program