MEDICARE: STACEY J STOUT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME0095291	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	68810	OTHER	FL	BCBS OF FL

General Provider Information

NPI Number	:	1356389068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY J STOUT M.D.

Provider Business Mailing Address
First Line	:	2000 PALM BEACH LAKES BLVD STE 901
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6506
Country	:	US
Telephone Number	:	561-509-5009
Fax Number	:	561-738-1822

Provider Business Practice Location Address
First Line	:	6080 BOYNTON BEACH BLVD STE 240
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3586
Country	:	US
Telephone Number	:	561-509-5009
Fax Number	:	561-738-0556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	09/23/2025

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