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NPI Code Detail

MEDICARE: DR. LUCAS JAY STOUT DO

MEDICARE: DR. LUCAS JAY STOUT DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician011953AZ

General Provider Information

NPI Number : 1578315081
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LUCAS JAY STOUT DO
Provider Business Mailing Address
First Line : 3100 N CENTRAL AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2637
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2601 E ROOSEVELT ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-4973
Country : US
Telephone Number : 602-344-5011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2024
Last Update Date : 12/12/2025

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Directions to “ DR. LUCAS JAY STOUT DO” Practice Location

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