Healthcare Provider Details

I. General information

NPI: 1760697783
Provider Name (Legal Business Name): CHRISTOPHER LEE STOUT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5433 W WALSH LN
ROGERS AR
72758-8946
US

IV. Provider business mailing address

5433 W WALSH LN
ROGERS AR
72758-8946
US

V. Phone/Fax

Practice location:
  • Phone: 479-464-8346
  • Fax:
Mailing address:
  • Phone: 479-464-8346
  • Fax: 479-464-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number56370
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101247398
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberE-14776
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: