Individual
JORDAN LEE BLACKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
652 S MEDICAL CENTER DR STE 120, SAINT GEORGE, UT 84790-7077
(435) 628-4460
(435) 251-3601
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(435) 628-4460
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8678933-1206
UT
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/16/2019
Last updated
06/08/2026
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