Individual
JASON LEE BLACKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
2981404
ID
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
7216493-1205
UT
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
MD.MD.70131894
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00685134
MEDICARE RAILROAD
UT
Enumeration date
06/16/2007
Last updated
07/09/2026
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