Healthcare Provider Details

I. General information

NPI: 1598127938
Provider Name (Legal Business Name): JACOB R BLOUNT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 03/25/2024
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST STE 3400
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

4504 69TH ST
SACRAMENTO CA
95820-4328
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-4597
  • Fax:
Mailing address:
  • Phone: 573-881-4572
  • Fax: 573-815-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberDR.0062221
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberDR.0062221
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA172761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: