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Contact Information

JASON L BLACKHAM, MD
4403 HARRISON BLVD
SUITE 2400
OGDEN, UT84403-3271
 Phone: 801-387-2750
 Fax: 801-387-2755
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Sports Medicine

207RS0010X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for JASON L BLACKHAM · (Male)

NPI Number 1821293242
Status Active
Credentials MD
Entity Individual
Enumeration date 06/16/2007
Last updated 09/22/2011 - About 15 years ago
Sole proprietor 1 No
Identifiers
  • UT License # 7216493-1205
  • UT Other P00685134 MEDICARE RAILROAD
Hospital affiliation(s)
  • MCKAY DEE HOSPITAL CENTER - (Acute Care)
    4401 HARRISON BOULEVARD
    OGDEN, UT 84403
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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