Provider Demographics
NPI:1447245691
Name:CALVIN BLOUNT JR MD PA
Entity Type:Organization
Organization Name:CALVIN BLOUNT JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLOUNT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:850-837-4844
Mailing Address - Street 1:PO BOX 6354
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-1003
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
44250OtherBCBS
BB4571673OtherDEA
G41400Medicare UPIN
FL44250ZMedicare PIN