Provider Demographics
NPI:1760420590
Name:BLACKSHER, JAMES U III (PAC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:U
Last Name:BLACKSHER
Suffix:III
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:ID
Mailing Address - Zip Code:83611-1330
Mailing Address - Country:US
Mailing Address - Phone:208-382-4242
Mailing Address - Fax:208-382-3580
Practice Address - Street 1:402 LAKE CASCADE PKWY
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:ID
Practice Address - Zip Code:83611-7702
Practice Address - Country:US
Practice Address - Phone:208-382-4242
Practice Address - Fax:208-382-3580
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002857502Medicaid
ID002857502Medicaid
UTR34072Medicare UPIN