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General NPI Number Information
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NPI Number | 1356389068
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Entity Type | Individual
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Provider Name | STACEY J STOUT M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 6080 BOYNTON BEACH BLVD STE 240
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-3586
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Country | US
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Telephone | 561-509-5009
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Fax | 561-738-0556
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Provider Business Mailing Address
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Address Line | 2000 PALM BEACH LAKES BLVD STE 901
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-6506
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Country | US
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Telephone | 561-509-5009
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Fax | 561-738-1822
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME0095291
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License Number State | FL
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