Provider Demographics
NPI:1609842137
Name:STOUT, PAUL WADE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WADE
Last Name:STOUT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 100559
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0559
Mailing Address - Country:US
Mailing Address - Phone:843-664-4300
Mailing Address - Fax:843-664-4308
Practice Address - Street 1:1 SAINT VINCENT CIR
Practice Address - Street 2:SUITE 160
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5405
Practice Address - Country:US
Practice Address - Phone:501-663-4116
Practice Address - Fax:501-663-4301
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2008-01-02
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Provider Licenses
StateLicense IDTaxonomies
ARC8471207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K985Medicare PIN
G80442Medicare UPIN