Provider Demographics
NPI:1639954142
Name:STOUT, EVAN THOMAS
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:THOMAS
Last Name:STOUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13907 W 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-6820
Mailing Address - Country:US
Mailing Address - Phone:302-690-8855
Mailing Address - Fax:
Practice Address - Street 1:13907 W 22ND AVE
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-6820
Practice Address - Country:US
Practice Address - Phone:302-690-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant