Provider Demographics
NPI:1316930688
Name:STOUT, TIMOTHY MARK (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MARK
Last Name:STOUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1275 DICK LONAS RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1382
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-381-1509
Practice Address - Street 1:320 CHESHIRE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5813
Practice Address - Country:US
Practice Address - Phone:800-500-4667
Practice Address - Fax:833-448-2982
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMD108395207W00000X
KS0429147207W00000X
TNMD68554207W00000X
KS04-29147207WX0107X
TN68554207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180041348OtherRAILROAD MEDICARE
180041349OtherRAILROAD MEDICARE
180041349OtherRAILROAD MEDICARE
G91188Medicare UPIN