Individual
KELBY STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
335 FAIRIVEW ST, SILVERTON, OR 97381-1200
(503) 873-8686
(503) 873-8689
Mailing address
335 FAIRIVEW ST, SILVERTON, OR 97381-1200
(503) 873-8686
(503) 873-8689
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA160806
OR
Other
Enumeration date
10/31/2012
Last updated
03/08/2013
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