Provider Demographics
NPI:1699796862
Name:BLUNT, LINDA M (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:BLUNT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5010
Mailing Address - Country:US
Mailing Address - Phone:575-627-4200
Mailing Address - Fax:575-627-4212
Practice Address - Street 1:1112 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5010
Practice Address - Country:US
Practice Address - Phone:575-627-4200
Practice Address - Fax:575-627-4212
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21795207Q00000X
NMMD2015-0876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM67975828Medicaid
OK100066950CMedicaid
OK100066950CMedicaid
NM67975828Medicaid