Healthcare Provider Details

I. General information

NPI: 1336849439
Provider Name (Legal Business Name): ELEANOR STOUT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48TH MDG/RAF LAKENHEATH
APO AE
09461
US

IV. Provider business mailing address

48TH MDG/RAF LAKENHEATH
APO AE
09461
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102208709
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: