JUDY BLACK M.D. NPI 1770786667

NPI Information

NPI: 1770786667
Provider Name: JUDY BLACK, M.D.
Classification: Pediatrics - 208000000X
Entity Type: Individual
PECOS Registration: Yes
Address: 1937 W HARVARD AVE
ROSEBURG, OR
ZIP 97471
Phone: (541) 677-7200

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NPI Details

Judy Black, M.D. is a pediatrics in Roseburg, OR. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. Judy Black, M.D. NPI is 1770786667. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1937 W HARVARD AVE
ROSEBURG, OR
ZIP 97471-720
Phone: (541) 677-7200
Fax: (541) 229-3309

The NPI 1770786667 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/7/2007 and was last updated on 8/7/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	208000000X	Pediatrics	MD 170104	OREGON	Yes
2	202C00000X	Independent Medical Examiner	036113715	ILLINOIS	No
3	208000000X	Pediatrics	MD170104	OREGON	No
4	208000000X	Pediatrics	036113715	ILLINOIS	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	500680833	MEDICAID	OREGON
2	036113715	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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