Provider Demographics
NPI:1497721328
Name:STOUT, STEPHEN Y (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:Y
Last Name:STOUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 MAC LANE
Mailing Address - Street 2:AVERA MEDICAL GROUP PIERRE
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501
Mailing Address - Country:US
Mailing Address - Phone:605-224-7070
Mailing Address - Fax:605-224-5214
Practice Address - Street 1:100 MAC LANE
Practice Address - Street 2:AVERA MEDICAL GROUP PIERRE
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501
Practice Address - Country:US
Practice Address - Phone:605-224-7070
Practice Address - Fax:605-224-2514
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2012-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SD1625207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6400402Medicaid
SDD25630Medicare UPIN
SD6400402Medicaid