Individual
JACK STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
222 E RIDGE RD, SUITE 204, MCALLEN, TX 78503-1251
(956) 632-6020
(956) 630-6643
Mailing address
PO BOX 1672, SAN ANTONIO, TX 78296-1672
(956) 632-6020
(965) 630-6643
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
229533
TX
Other
Enumeration date
08/13/2006
Last updated
07/08/2007
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