MEDICARE: MR. ROY DEWAYNE BLOUNT P.A.

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
1	363AM0700X	Medical Physician Assistant	PA10680	TX

General Provider Information

NPI Number	:	1922176817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROY DEWAYNE BLOUNT P.A.

Provider Business Mailing Address
First Line	:	1919 ROGERS RD
Second Line	:	SUITE 104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4614
Country	:	US
Telephone Number	:	210-541-0700
Fax Number	:	210-541-6868

Provider Business Practice Location Address
First Line	:	1919 ROGERS RD
Second Line	:	SUITE 104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4614
Country	:	US
Telephone Number	:	210-541-0700
Fax Number	:	210-541-6868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/12/2018

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