Provider Demographics
NPI:1447241617
Name:BLACK, AMY WILLIAMS (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:WILLIAMS
Last Name:BLACK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:6600 BRUCEVILLE RD
Mailing Address - Street 2:DEPARTMENT OF ORTHOPEDICS
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-4671
Mailing Address - Country:US
Mailing Address - Phone:916-688-2030
Mailing Address - Fax:916-688-6314
Practice Address - Street 1:DEPARTMENT OF ORTHOPEDICS
Practice Address - Street 2:6600 BRUCEVILLE ROAD
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823
Practice Address - Country:US
Practice Address - Phone:916-688-2030
Practice Address - Fax:916-688-6314
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2021-12-23
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Provider Licenses
StateLicense IDTaxonomies
CAA76147207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I32492Medicare UPIN