Provider Demographics
NPI:1053674499
Name:HOWARD BLOUNT MD PA
Entity Type:Organization
Organization Name:HOWARD BLOUNT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-291-9500
Mailing Address - Street 1:6388 SILVER STAR RD
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-3235
Mailing Address - Country:US
Mailing Address - Phone:407-291-9500
Mailing Address - Fax:407-291-9599
Practice Address - Street 1:6388 SILVER STAR RD
Practice Address - Street 2:SUITE 2G
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3235
Practice Address - Country:US
Practice Address - Phone:407-291-9500
Practice Address - Fax:407-291-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057537174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063531601Medicaid
FLE59056Medicare UPIN
FL063531601Medicaid