Healthcare Provider Details

I. General information

NPI: 1639448244
Provider Name (Legal Business Name): CAREY A. BLEDSOE, D.P.M., A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 12/28/2011
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 Number
License Number State

VIII. Authorized Official

Name: DR. CAREY A BLEDSOE
Title or Position: PRESIDENT/CHIEF EXECUTIVE OFFICER
Credential: DPM, MS, FACFAS
Phone: 909-946-6643