Provider Demographics
NPI:1558161695
Name:BLOXHAM, SAMUEL ADAM (PA-C)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ADAM
Last Name:BLOXHAM
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2286 MALAGA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5485
Mailing Address - Country:US
Mailing Address - Phone:435-215-3444
Mailing Address - Fax:
Practice Address - Street 1:2286 MALAGA AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765-5485
Practice Address - Country:US
Practice Address - Phone:435-215-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14206396-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant