Provider Demographics
NPI:1790829208
Name:STOUT, WARREN C (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:C
Last Name:STOUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:800 E. COLORADO BLVD.
Mailing Address - Street 2:SUITE 260
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101
Mailing Address - Country:US
Mailing Address - Phone:626-449-6494
Mailing Address - Fax:626-449-0813
Practice Address - Street 1:800 E. COLORADO BLVD.
Practice Address - Street 2:SUITE 260
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101
Practice Address - Country:US
Practice Address - Phone:626-449-6494
Practice Address - Fax:626-449-0813
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG46809207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG46809AMedicare ID - Type UnspecifiedMEDICARE PPIN #
CAB57860Medicare UPIN