Individual
DR. CHARLES WILLIAM STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3670 PARKER BLVD, SUITE 101, PUEBLO, CO 81008-2285
(719) 564-1544
(719) 924-1593
Mailing address
3670 PARKER BLVD, SUITE 101, PUEBLO, CO 81008-2285
(719) 564-1544
(719) 924-1593
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
33411
AZ
207RC0001X
Clinical Cardiac Electrophysiology Physician
33411
AZ
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
48744
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01180773
—
CO
01
—
P00997270
RAILROAD MEDICARE
CO
Enumeration date
08/10/2005
Last updated
02/28/2017
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