Provider Demographics
NPI:1205932670
Name:LINDA M. BLUNT, M.D., PLLC
Entity type:Organization
Organization Name:LINDA M. BLUNT, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLUNT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PLLC
Authorized Official - Phone:918-343-3339
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74018-0695
Mailing Address - Country:US
Mailing Address - Phone:918-343-3339
Mailing Address - Fax:918-341-3212
Practice Address - Street 1:213 E PATTI PAGE BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-8218
Practice Address - Country:US
Practice Address - Phone:918-343-3339
Practice Address - Fax:918-341-3212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21795261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK410260696-001OtherBLUECROSS BLUESHIELD ID#
OK410260696-001OtherBLUECROSS BLUESHIELD ID#
OK410260696-001OtherBLUECROSS BLUESHIELD ID#