Provider Demographics
NPI:1679770994
Name:STOUT, CHARLES EMMET JR (MD, PHD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:EMMET
Last Name:STOUT
Suffix:JR
Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:700 E REDLANDS BLVD # 714
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6109
Mailing Address - Country:US
Mailing Address - Phone:951-338-4910
Mailing Address - Fax:833-996-0004
Practice Address - Street 1:4445 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4135
Practice Address - Country:US
Practice Address - Phone:951-338-4910
Practice Address - Fax:833-996-0004
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2023-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA1005772085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology