Provider Demographics
NPI:1275587586
Name:BLEDSOE, SCOTT C (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:C
Last Name:BLEDSOE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:DEPT 34929
Mailing Address - Street 2:P.O. BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:2400 BALFOUR RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4945
Practice Address - Country:US
Practice Address - Phone:925-308-8112
Practice Address - Fax:925-308-8710
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A8187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX81870Medicaid
CAH71587Medicare UPIN
CAP00180266Medicare PIN
CA020A81872Medicare PIN