Provider Demographics
NPI:1821228487
Name:BLEDSOE, IAN (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:BLEDSOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:IAN
Other - Middle Name:
Other - Last Name:BLEDSOE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1635 DIVISADERO ST STE 520
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3044
Mailing Address - Country:US
Mailing Address - Phone:415-353-2311
Mailing Address - Fax:415-353-9060
Practice Address - Street 1:1635 DIVISADERO ST STE 520
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3044
Practice Address - Country:US
Practice Address - Phone:415-353-2311
Practice Address - Fax:415-353-9060
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18212284872084N0400X
CAA1165772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology