Provider Demographics
NPI:1184668253
Name:STOUT, RODNEY B (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:B
Last Name:STOUT
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-441-2133
Mailing Address - Fax:740-446-5573
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5763
Practice Address - Fax:740-446-5573
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18824207RE0101X
OH35-06-8415207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0087542000Medicaid
OH0157744Medicaid
OH460001103OtherRR MEDICARE
001714085OtherMOUNTAIN STATE BCBS
OH000000185216OtherUNISON MEDICAID #
OH0157744OtherMOLINA MEDICAID #
000000007375OtherANTHEM BCBS
OH310917085115OtherCARESOURCE MEDICAID #
OH460001103OtherRR MEDICARE
001714085OtherMOUNTAIN STATE BCBS
OH0157744OtherMOLINA MEDICAID #