Provider Demographics
NPI:1952325524
Name:BLEDSOE, PATRICIA A (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2456 N WOODLAWN BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3968
Mailing Address - Country:US
Mailing Address - Phone:316-866-2905
Mailing Address - Fax:316-558-3392
Practice Address - Street 1:2456 N WOODLAWN BLVD
Practice Address - Street 2:STE 200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3968
Practice Address - Country:US
Practice Address - Phone:316-866-2905
Practice Address - Fax:316-558-3392
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0429547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
510370OtherFIRST GUARD
105335OtherBLUE CROSS BLUE SHIELD
KS100455070BMedicaid
H67577Medicare UPIN