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Contact Information

BRENDA K BLACKHAM, MD
5770 FASHION BLVD
MURRAY, UT84107-6548
 Phone: 801-993-9582
 Fax: 801-733-5618
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anesthesiology

207L00000X 79 Physician/Addiction Medicine
Indicates primary specialty

NPI Profile & details for BRENDA K BLACKHAM · (Female)

NPI # 1174635494
Status Active
Credentials MD
Entity Individual
Enumeration date 08/31/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • UT License # 90183338-1205
  • AZ Medicaid 824723
  • WY Medicaid 1189492500
  • UT Other QM0000075886 ALTIUS
  • UT Other 305404 DESERET MUTUAL
  • UT Other 870545614BL3 EDUCATORS MUTUAL
  • UT Other 6761 HEALTHY U
  • UT Other 107005709102 IHC
  • UT Other PRA06458 MOLINA
  • UT Other 73606 PEHP
  • UT Other 1502954 UMWA
  • UT Other 2090168 UNITED HEALTHCARE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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