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NPI Code Detail

MEDICARE: BENROE W BLOUNT M.D.

MEDICARE: BENROE W BLOUNT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianME123575FL

General Provider Information

NPI Number : 1821193772
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENROE W BLOUNT M.D.
Provider Business Mailing Address
First Line : 1395 NW 167TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33169-5742
Country : US
Telephone Number : 305-831-4761
Fax Number : 305-831-4761
Provider Business Practice Location Address
First Line : 206 N FLORIDA AVE
Second Line :
City : LAKELAND
State : FL
Zip : 33801-4902
Country : US
Telephone Number : 863-209-7003
Fax Number : 863-284-3083
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2006
Last Update Date : 02/17/2017

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Directions to “ BENROE W BLOUNT M.D.” Practice Location

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