Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 0415510 | KS |
Y | 207W00000X | Ophthalmologist | MD32847 | MO |
NPI | 1023001393 |
---|---|
Provider Name | Dr. Carl N Stout JR. |
First Address | Independence, MO 64055-7015 |
Second Address | Independence, MO 64055-6974 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 06/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D96022 | (02) |