Provider Demographics
NPI:1396854899
Name:STOUT, DAVID C (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
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 1:4 PEBBLE CRK
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8370
Mailing Address - Country:US
Mailing Address - Phone:601-261-9323
Mailing Address - Fax:
Practice Address - Street 1:4 PEBBLE CRK
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8370
Practice Address - Country:US
Practice Address - Phone:601-261-9323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14328208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115125Medicaid
MS130011551OtherRAILROAD MEDICARE
MS640507572AVOtherAMERICAN ADMIN GROUP
MS130011551OtherRAILROAD MEDICARE
MS340000133Medicare PIN