Jordan Lee Blackham, PA-C

NPI #1790337046 in Saint George, Utah

Provider Information

NPI Number: 1790337046
Entity Type: Individual
Name: Jordan Lee Blackham, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Jul 16, 2019
Last Updated: Nov 6, 2020

Practice Location

Address: 652 S MEDICAL CENTER DR STE 120
City: Saint George
State: Utah
ZIP Code: 84790-7077
Phone: (435) 251-3600

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary
Student in an Organized Health Care Education/Training Program	390200000X

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