Individual
IVAN GENE BLEDSOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6606 LBJ FWY, SUITE 200, DALLAS, TX 75240
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
55042
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
726382
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100419530A
—
KS
05
—
198389201
—
TX
05
—
198389203
—
TX
01
—
8792UG
BCBS
TX
01
—
89574U
BLUE CROSS BLUE SHIELD
TX
05
—
917483901
—
MO
01
—
P00792988
RAILROAD
TX
01
—
P01445701
RAILRAOD
TX
Enumeration date
12/02/2005
Last updated
06/01/2018
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