Provider Demographics
NPI:1689646473
Name:BLUNCK, CARL ERNST (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:ERNST
Last Name:BLUNCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2055 NORMANDIE DR
Mailing Address - Street 2:108
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2732
Mailing Address - Country:US
Mailing Address - Phone:334-288-4624
Mailing Address - Fax:334-280-3628
Practice Address - Street 1:300 W OTTLEY AVE
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-2118
Practice Address - Country:US
Practice Address - Phone:970-858-2186
Practice Address - Fax:970-858-2208
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME552242085R0202X
AL000120362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B64062Medicare UPIN