Healthcare Provider Details

I. General information

NPI: 1164404588
Provider Name (Legal Business Name): CALVIN L BLOUNT JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2005
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 COMMONS DR W STE 120
DESTIN FL
32541-8424
US

IV. Provider business mailing address

4012 COMMONS DR W STE 120
DESTIN FL
32541-8424
US

V. Phone/Fax

Practice location:
  • Phone: 850-424-5474
  • Fax: 850-837-6625
Mailing address:
  • Phone: 850-424-5474
  • Fax: 850-837-6625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME76428
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: