Provider Demographics
NPI:1679535694
Name:STOUT, PAUL EDWARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:EDWARD
Last Name:STOUT
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2300 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3856
Mailing Address - Country:US
Mailing Address - Phone:910-822-2120
Mailing Address - Fax:910-482-5284
Practice Address - Street 1:2300 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3856
Practice Address - Country:US
Practice Address - Phone:910-822-2120
Practice Address - Fax:910-482-5284
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC100139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC100139OtherNCMB PA LICENSE