Provider Demographics
NPI:1669467544
Name:BLEDSOE, JAMES AARON (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:AARON
Last Name:BLEDSOE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:801-479-7771
Mailing Address - Fax:801-479-7795
Practice Address - Street 1:5740 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4869
Practice Address - Country:US
Practice Address - Phone:801-479-7771
Practice Address - Fax:801-479-7795
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT7352393-1204207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000095995Medicare PIN