Provider Demographics
NPI:1699771451
Name:STOUT, RONALD J (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:STOUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:700 W IRONWOOD DR
Mailing Address - Street 2:STE 236
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4484
Mailing Address - Country:US
Mailing Address - Phone:208-765-1345
Mailing Address - Fax:208-667-9622
Practice Address - Street 1:700 W IRONWOOD DR
Practice Address - Street 2:STE 236
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4484
Practice Address - Country:US
Practice Address - Phone:208-765-1345
Practice Address - Fax:208-667-9622
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM4778207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1010222Medicaid
MT0083147Medicaid
MT0083147Medicaid
WA1010222Medicaid