Provider Demographics
NPI:1487618138
Name:BLACK, JOHN HUNTER (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HUNTER
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 1:222 MEDICAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1181
Mailing Address - Country:US
Mailing Address - Phone:606-783-6808
Mailing Address - Fax:606-783-6906
Practice Address - Street 1:222 MEDICAL CIRCLE
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1181
Practice Address - Country:US
Practice Address - Phone:606-783-6808
Practice Address - Fax:606-783-6906
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13171207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64131717Medicaid
KY1274502Medicare ID - Type Unspecified
C78422Medicare UPIN