Provider Demographics
NPI:1750520946
Name:BLEDSOE, CHRIS SHAUN (MD)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:SHAUN
Last Name:BLEDSOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19141 STONE OAK PKWY
Mailing Address - Street 2:STE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-485-1844
Mailing Address - Fax:210-399-2730
Practice Address - Street 1:19141 STONE OAK PKWY
Practice Address - Street 2:STE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-485-1844
Practice Address - Fax:210-399-2730
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1557207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202789801Medicaid
TX8L13816OtherMEDICARE
TX265271ZPGZMedicare PIN