Provider Demographics
NPI:1336199603
Name:STOUT, DANIEL JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:STOUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46082-0312
Mailing Address - Country:US
Mailing Address - Phone:317-848-5494
Mailing Address - Fax:317-575-0392
Practice Address - Street 1:1120 AAA WAY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3210
Practice Address - Country:US
Practice Address - Phone:317-848-5494
Practice Address - Fax:317-575-0392
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025694A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4004458OtherAETNA
IN000000086078OtherANTHEM
IN000000086078OtherANTHEM
IN4004458OtherAETNA