Individual
BENJAMIN W BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8849 S REDWOOD RD, STE E-121, WEST JORDAN, UT 84088-5619
(801) 569-1999
(801) 569-2001
Mailing address
PO BOX 95970, SOUTH JORDAN, UT 84095-0970
(801) 352-9500
(801) 352-9502
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3458
AZ
363A00000X
Physician Assistant
Primary
8983610-1206
UT
Other
Enumeration date
08/30/2006
Last updated
10/14/2015
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