Healthcare Provider Details

I. General information

NPI: 1699771451
Provider Name (Legal Business Name): RONALD J STOUT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 236
COEUR D ALENE ID
83814-4484
US

IV. Provider business mailing address

700 W IRONWOOD DR STE 236
COEUR D ALENE ID
83814-4484
US

V. Phone/Fax

Practice location:
  • Phone: 208-765-1345
  • Fax: 208-667-9622
Mailing address:
  • Phone: 208-765-1345
  • Fax: 208-667-9622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberM4778
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: