Provider Demographics
NPI:1184964538
Name:STOUTERMIRE, TROY
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:
Last Name:STOUTERMIRE
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:TROY
Other - Middle Name:
Other - Last Name:STOUTERMIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:812 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-3821
Mailing Address - Country:US
Mailing Address - Phone:918-816-6750
Mailing Address - Fax:
Practice Address - Street 1:812 N 7TH ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-3821
Practice Address - Country:US
Practice Address - Phone:918-816-6750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator