Provider Demographics
NPI:1912158635
Name:BLEDSOE, BRYAN EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:EDWARD
Last Name:BLEDSOE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5235
Mailing Address - Country:US
Mailing Address - Phone:972-775-2612
Mailing Address - Fax:972-692-6987
Practice Address - Street 1:6420 HAYES RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5235
Practice Address - Country:US
Practice Address - Phone:972-775-2612
Practice Address - Fax:972-692-6987
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4172207P00000X
NVDO1418207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine