Bledsoe, Larry
Bledsoe, Larry is an sole proprietor health care provider with primary practice located at 620 W Berry St , Fort Wayne IN 46802-2106. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Bledsoe, Larry can be contacted via phone (260) 424-6311.Contact Information
Primary practice address
620 W Berry St
Fort Wayne IN 46802-2106
Phone: (260) 424-6311
Fax: (260) 424-6311
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 01028106 | Indiana |
| Allopathic & Osteopathic Physicians / Geriatric Medicine | 207RG0300X | 01028106 | Indiana |
Profile Details
| NPI number | 1396763702 |
|---|---|
| LBN Legal business name | Bledsoe, Larry |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 17th, 2006 |
| Last updated | Sep 1st, 2016 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1396763702 | NPPES |
| Indiana | MEDICAID | 100061080A |
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