Individual
LARRY BLEDSOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
620 W BERRY ST, FORT WAYNE, IN 46802-2106
(260) 424-6311
(260) 424-6311
Mailing address
620 W BERRY ST, FORT WAYNE, IN 46802-2106
(260) 424-6311
(260) 424-6311
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01028106
IN
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
01028106
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100061080A
—
IN
Enumeration date
07/17/2006
Last updated
09/01/2016
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