Healthcare Provider Details

I. General information

NPI: 1760656391
Provider Name (Legal Business Name): JOSEPH ROBERT BLEDSOE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5373 S GREEN ST
MURRAY UT
84123-4680
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-442-5271
  • Fax:
Mailing address:
  • Phone: 801-442-5271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number6353628-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: