Provider Demographics
NPI:1508902321
Name:BLEDSOE, JAMES R (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:BLEDSOE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:207 W BEN FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CORRIGAN
Mailing Address - State:TX
Mailing Address - Zip Code:75939-2042
Mailing Address - Country:US
Mailing Address - Phone:936-398-5555
Mailing Address - Fax:936-398-5559
Practice Address - Street 1:207 W BEN FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CORRIGAN
Practice Address - State:TX
Practice Address - Zip Code:75939-2042
Practice Address - Country:US
Practice Address - Phone:936-398-5555
Practice Address - Fax:936-398-5559
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA 00564363AS0400X
TXPA00564363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical