Provider Demographics
NPI:1164404588
Name:BLOUNT, CALVIN L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:L
Last Name:BLOUNT
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:4012 COMMONS DR W
Mailing Address - Street 2:STE 120
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-8424
Mailing Address - Country:US
Mailing Address - Phone:850-837-4844
Mailing Address - Fax:850-837-6625
Practice Address - Street 1:12607 US HIGHWAY 98 W
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-6825
Practice Address - Country:US
Practice Address - Phone:850-837-4844
Practice Address - Fax:850-837-6625
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-20
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
FLME76428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255279500Medicaid
FLME76428OtherSTATE LICENSE
FL5903676OtherAETNA INSURANCE
FL593553504OtherCHAMPUS
FL593553504OtherGREAT WEST
FL080146219OtherMDC RAILROAD
FL44250OtherBLUE CROSS BLUE SHIELD
FL44250OtherBLUE CROSS BLUE SHIELD
FLG41400Medicare UPIN
FL255279500Medicaid