Provider Demographics
NPI:1528394368
Name:BLOUNT, ROBERT EARL (N/A)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EARL
Last Name:BLOUNT
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80165
Mailing Address - Street 2:600 COMMON ST
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71148-0165
Mailing Address - Country:US
Mailing Address - Phone:318-347-2208
Mailing Address - Fax:318-221-3750
Practice Address - Street 1:600 COMMON ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3432
Practice Address - Country:US
Practice Address - Phone:318-425-6213
Practice Address - Fax:318-221-3750
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator