Individual
ALICE B BLOUNT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
20102 COUGAR TRL, CHRISTOVAL, TX 76935-1605
(574) 339-5120
Mailing address
PO BOX 22000, SAN ANGELO, TX 76902-7200
(325) 658-1511
(325) 481-2165
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
M6053
TX
207Q00000X
Family Medicine Physician
11012388
IN
207Q00000X
Family Medicine Physician
Primary
M6053
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191113301
—
TX
01
—
8B7582
BLUE CROSS BLUE SHIELD OF TEXAS
TX
01
—
P00471769
MEDICARE RAILROAD
TX
Enumeration date
04/10/2007
Last updated
01/06/2022
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