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NPI Code Detail

MEDICARE: RICHARD BRENNAN BLACKHAM M.D.

MEDICARE: RICHARD BRENNAN BLACKHAM M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12081P2900XPain Medicine (Physical Medicine & Rehabilitation) Physician8627317-1205UT
22081P2900XPain Medicine (Physical Medicine & Rehabilitation) Physician46108AZ

General Provider Information

NPI Number : 1043470990
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD BRENNAN BLACKHAM M.D.
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 801-507-9800
Fax Number :
Provider Business Practice Location Address
First Line : 5171 S COTTONWOOD ST STE 180
Second Line :
City : MURRAY
State : UT
Zip : 84107-5704
Country : US
Telephone Number : 801-507-9800
Fax Number : 801-507-9801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2008
Last Update Date : 06/08/2026

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