Provider Demographics
NPI:1962487009
Name:STOUT, DAVID R (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:STOUT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:225 S PINE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2365
Mailing Address - Country:US
Mailing Address - Phone:812-524-3333
Mailing Address - Fax:812-524-3334
Practice Address - Street 1:225 S PINE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2365
Practice Address - Country:US
Practice Address - Phone:812-524-3333
Practice Address - Fax:812-524-3334
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01027578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000092363OtherANTHEM
C24903Medicare UPIN
IN000000092363OtherANTHEM