Individual
BLAKE NELSON JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1784 UINTA WAY STE E, PARK CITY, UT 84098-7669
(435) 604-0160
Mailing address
892 S 30 E, SALEM, UT 84653-5305
(435) 227-6263
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
UT
Other
Enumeration date
11/04/2025
Last updated
11/04/2025
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