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General NPI Number Information
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NPI Number | 1316930688
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Entity Type | Individual
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Provider Name | TIMOTHY MARK STOUT MD
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Gender | Male
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 320 CHESHIRE DR
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City | KNOXVILLE
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State | TN
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Zip | 37919-5813
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Country | US
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Telephone | 800-500-4667
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Fax | 833-448-2982
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Provider Business Mailing Address
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Address Line | 1275 DICK LONAS RD
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City | KNOXVILLE
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State | TN
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Zip | 37909-1382
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Country | US
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Telephone | 865-584-4747
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Fax | 865-381-1509
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD108395
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0429147
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD68554
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 04-29147
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License Number State | KS
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Taxonomy #5
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 68554
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License Number State | TN
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