Individual
LISA STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1060 E 100 S, STE 110, SALT LAKE CITY, UT 84102-1591
(801) 531-9453
(801) 531-9467
Mailing address
1060 E 100 S, STE 110, SALT LAKE CITY, UT 84102-1591
(801) 531-9453
(801) 531-9467
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
373658-1205
UT
208800000X
Urology Physician
Primary
373658-1205
UT
Other
Enumeration date
05/24/2005
Last updated
03/06/2017
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