Healthcare Provider Details

I. General information

NPI: 1558352971
Provider Name (Legal Business Name): CAREY A BLEDSOE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SAN BERNARDINO RD SUITE 104
UPLAND CA
91786-4912
US

IV. Provider business mailing address

901 SAN BERNARDINO RD SUITE 104
UPLAND CA
91786-4912
US

V. Phone/Fax

Practice location:
  • Phone: 909-946-6643
  • Fax: 909-946-6130
Mailing address:
  • Phone: 909-946-6643
  • Fax: 909-946-6130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4008
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number260
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: