Provider Demographics
NPI:1831136175
Name:BLOUNT, PHILIP J (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:BLOUNT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1350 EAST WOODROW WILSON DR.
Mailing Address - Street 2:METHODIST REHABILITATION CENTER
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-936-8801
Mailing Address - Fax:601-936-8808
Practice Address - Street 1:1410 E WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5114
Practice Address - Country:US
Practice Address - Phone:601-936-8801
Practice Address - Fax:601-936-8808
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18478208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2154523Medicaid
MSP00601559OtherRRCARE PTAN
MS302I257039OtherPTAN
MS302I257039OtherPTAN
MSBB8321630OtherDEA
MS250000063Medicare ID - Type Unspecified