Provider Demographics
NPI:1275691925
Name:STOUTE, JOSE ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:STOUTE
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 1:4430A SHERIDAN ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3514
Mailing Address - Country:US
Mailing Address - Phone:954-962-0040
Mailing Address - Fax:954-962-7901
Practice Address - Street 1:4430A SHERIDAN ST STE A
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3514
Practice Address - Country:US
Practice Address - Phone:954-962-0040
Practice Address - Fax:954-962-7901
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029798207RI0200X
PAMD434601207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022374060001Medicaid
PA136375Medicare PIN