Provider Demographics
NPI:1588687115
Name:BLEDIN, ANTHONY G (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:G
Last Name:BLEDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 HOLSER WALK
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2626
Mailing Address - Country:US
Mailing Address - Phone:805-988-1111
Mailing Address - Fax:805-988-0254
Practice Address - Street 1:1851 HOLSER WALK
Practice Address - Street 2:SUITE 220
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2626
Practice Address - Country:US
Practice Address - Phone:805-988-1111
Practice Address - Fax:805-988-0254
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42124174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C421240Medicaid
W10935AMedicare PIN
CA00C421240Medicaid
CAA37749Medicare UPIN