Provider Demographics
NPI:1366415234
Name:STOUT, PATRICK EARL (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:EARL
Last Name:STOUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:918-540-7870
Mailing Address - Fax:918-540-7394
Practice Address - Street 1:310 2ND AVE SW
Practice Address - Street 2:STE. 208
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6743
Practice Address - Country:US
Practice Address - Phone:918-540-7870
Practice Address - Fax:918-540-7394
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19779208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200468380SMedicaid
OK100044840AMedicaid
KS100270540AMedicaid
MO208578401Medicaid
KS100270540AMedicaid
340012471Medicare PIN
OK200468380SMedicaid
MO208578401Medicaid
CJ3031Medicare PIN