Provider Demographics
NPI:1023154242
Name:BLOUNT, ROBERT JESSE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JESSE
Last Name:BLOUNT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR # C33GH
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-4419
Mailing Address - Fax:
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-4419
Practice Address - Fax:928-674-7705
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD448452080P0214X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ818304Medicaid
AZ8HBV04Medicare ID - Type UnspecifiedMEDICARE PART B - TSAILE
AZH98350Medicare UPIN
AZ8HBV02Medicare ID - Type UnspecifiedMEDICARE PART B - CHINLE
AZ8HBV03Medicare ID - Type UnspecifiedMEDICARE PART B - PINON