Individual
TIMOTHY RAY STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9119 S 90TH EAST AVE, TULSA, OK 74133-5607
(918) 693-0161
Mailing address
9119 S 90TH EAST AVE, TULSA, OK 74133-5607
(918) 693-0161
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/21/2023
Last updated
08/21/2023
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