MEDICARE: DR. CALVIN L BLOUNT JR. 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
1	207Q00000X	Family Medicine Physician	ME76428	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ME76428	OTHER	FL	STATE LICENSE
3	5903676	OTHER	FL	AETNA INSURANCE
4	593553504	OTHER	FL	CHAMPUS
5	593553504	OTHER	FL	GREAT WEST
6	080146219	OTHER	FL	MDC RAILROAD
7	44250	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1164404588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CALVIN L BLOUNT JR. M.D.

Provider Business Mailing Address
First Line	:	4012 COMMONS DR W STE 120
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-8424
Country	:	US
Telephone Number	:	850-424-5474
Fax Number	:	850-837-6625

Provider Business Practice Location Address
First Line	:	4012 COMMONS DR W STE 120
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-8424
Country	:	US
Telephone Number	:	850-424-5474
Fax Number	:	850-837-6625

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

Provider Enumeration Date	:	11/20/2005
Last Update Date	:	05/18/2026

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