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
Fax: (260) 424-6311
Website:

Health care specialties

SpecialtyCodeLicense #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 9 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396763702 NPPES
Indiana MEDICAID 100061080A

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