Provider Demographics
NPI:1043635139
Name:STOUT, JAMES JR
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:STOUT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 NE 45TH ST STE 119
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5135
Mailing Address - Country:US
Mailing Address - Phone:954-993-6150
Mailing Address - Fax:888-578-9669
Practice Address - Street 1:1919 NE 45TH ST STE 119
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5135
Practice Address - Country:US
Practice Address - Phone:954-993-6150
Practice Address - Fax:888-578-9669
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies