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Individual

DR. JACOB BLAINE OLDHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
4830 HIGHWAY 260 STE 103, LAKESIDE, AZ 85929-5851
(928) 537-8777
(928) 537-1914
Mailing address
4830 HIGHWAY 260 STE 103, LAKESIDE, AZ 85929-5851
(928) 537-8777
(928) 537-1914

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
41236
AZ
207X00000X
Orthopaedic Surgery Physician
MD2005-0490
NM

Other

Enumeration date
10/25/2005
Last updated
10/20/2022
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