Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | CPO02785 | OR |
Y | 222Z00000X | Podiatrist | CPO02785 | OR |
N | 224P00000X | Prosthetist | CPO02785 | OR |
NPI | 1447703707 |
---|---|
Provider Name | Ron Stout |
First Address | Orlando, FL 32886-5109 |
Second Address | Portland, OR 97239-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2016 |
Last Update Date | 03/08/2016 |