Healthcare Provider Details

I. General information

NPI: 1346232055
Provider Name (Legal Business Name): MARY CLAIRE BLEDSOE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARITA C BLEDSOE MD

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS WAY # 512-1
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

PO BOX 4283
EAGLE CO
81631-4283
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-1100
  • Fax: 501-364-4082
Mailing address:
  • Phone: 970-471-3947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33899
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-18651
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: