Blackham, Jason Lee

Blackham, Jason Lee is an individual health care provider with primary practice located at 4403 Harrison Blvd Suite 2400, Ogden UT 84403-3271. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Blackham, Jason Lee can be contacted via phone (801) 387-2750.

Contact Information

Primary practice address
4403 Harrison Blvd Suite 2400 Ogden UT 84403-3271
Phone: (801) 387-2750
Fax: (801) 387-2755
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207RS0010X 7216493-1205 Utah

Profile Details

NPI number 1821293242
LBN Legal business name Blackham, Jason Lee
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2007
Last updated Sep 22nd, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821293242 NPPES
Utah Other P00685134 MEDICARE RAILROAD

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