Provider Demographics
NPI:1346549979
Name:STOUT, LISA MICHELLE (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:STOUT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:897 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1029
Mailing Address - Country:US
Mailing Address - Phone:207-564-4464
Mailing Address - Fax:207-564-4461
Practice Address - Street 1:891 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1059
Practice Address - Country:US
Practice Address - Phone:207-564-4464
Practice Address - Fax:207-564-4461
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEDO2452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine