Provider Demographics
NPI:1396817409
Name:BLEDSOE, ROBERT CHANDLER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHANDLER
Last Name:BLEDSOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W COLLEGE ST STE 380
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3583
Mailing Address - Country:US
Mailing Address - Phone:817-481-0868
Mailing Address - Fax:817-481-1378
Practice Address - Street 1:1600 W COLLEGE ST STE 380
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3583
Practice Address - Country:US
Practice Address - Phone:817-481-0868
Practice Address - Fax:817-481-1378
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4836174400000X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89911ZOtherBCBS PROVIDER ID
TX89911ZOtherBCBS PROVIDER ID