| Doctor Name: | JOHN WALTON BLACK |
| NPI Number: | 1013221738 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 932 Pearl St Bowling Green, OH - 434022613 |
| Business Phone Number: | 4192702774 |
| Business Fax Number: | |
| Mailing Address: | 932 Pearl St, BOWLING GREEN |
| State: | OH |
| Postal Code: | 434022613 |
| Phone Number: | 4192702774 |
| Fax Number: | |
| NPI Enumeration Date: | 08/05/2010 |
| NPI Last Update Date: | 08/05/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |