Provider Demographics
NPI:1275550162
Name:BLOUNT, FARRIS JR (MD)
Entity Type:Individual
Prefix:
First Name:FARRIS
Middle Name:
Last Name:BLOUNT
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1315 ST JOSEPH PKWY
Mailing Address - Street 2:SUITE 1507
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8233
Mailing Address - Country:US
Mailing Address - Phone:713-650-6556
Mailing Address - Fax:713-659-7907
Practice Address - Street 1:1315 ST JOSEPH PKWY
Practice Address - Street 2:SUITE 1507
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8233
Practice Address - Country:US
Practice Address - Phone:713-650-6556
Practice Address - Fax:713-659-7907
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2010-06-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG8008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135142109Medicaid
TX8W2122OtherBCBS
TX135142109Medicaid
TX8W2122OtherBCBS