Individual
MR. JIMMY DALE STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA CHAPLAIN
Contact information
Practice address
8960 N AGATE PLACE, TUCSON, AZ 85742
(520) 241-8608
Mailing address
8960 N AGATE PL, TUCSON, AZ 85742-9418
(520) 241-8608
Taxonomy
Speciality
Code
Description
License number
State
171R00000X
Interpreter
—
—
174400000X
Specialist
Primary
—
—
Other
Enumeration date
02/15/2007
Last updated
06/20/2014
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