Healthcare Provider Details

I. General information

NPI: 1447245691
Provider Name (Legal Business Name): CALVIN BLOUNT JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
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: 850-837-4844
  • 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: DR. CALVIN L BLOUNT JR.
Title or Position: CEO
Credential: MD
Phone: 850-424-5474