Provider Demographics
NPI:1841213600
Name:STOUT, HOBIN ROY (CRNA)
Entity Type:Individual
Prefix:MR
First Name:HOBIN
Middle Name:ROY
Last Name:STOUT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2742 EDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-1008
Mailing Address - Country:US
Mailing Address - Phone:337-480-9554
Mailing Address - Fax:
Practice Address - Street 1:2742 EDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-1008
Practice Address - Country:US
Practice Address - Phone:337-480-9554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX726211367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1912693Medicaid
TX1912693Medicaid