Provider Demographics
NPI:1346232055
Name:BLEDSOE, MARY CLAIRE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CLAIRE
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARITA
Other - Middle Name:
Other - Last Name:BLEDSOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1606 PRAIRIE CENTER PARKWAY
Mailing Address - Street 2:#300
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601
Mailing Address - Country:US
Mailing Address - Phone:303-655-1685
Mailing Address - Fax:303-655-1703
Practice Address - Street 1:1606 PRAIRIE CENTER PARKWAY
Practice Address - Street 2:#300
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601
Practice Address - Country:US
Practice Address - Phone:303-655-1685
Practice Address - Fax:303-655-1703
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33899208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01338995Medicaid
G21357Medicare UPIN