Provider Demographics
NPI:1639448244
Name:CAREY A. BLEDSOE, D.P.M., A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CAREY A. BLEDSOE, D.P.M., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLEDSOE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, MS, FACFAS
Authorized Official - Phone:909-946-6643
Mailing Address - Street 1:901 SAN BERNARDINO RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4912
Mailing Address - Country:US
Mailing Address - Phone:909-946-6643
Mailing Address - Fax:909-946-6130
Practice Address - Street 1:901 SAN BERNARDINO RD
Practice Address - Street 2:SUITE 104
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4912
Practice Address - Country:US
Practice Address - Phone:909-946-6643
Practice Address - Fax:909-946-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty