Individual
MR. JERRY LEE STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OST
Contact information
Practice address
7379 W NORTH AVE, RIVER FOREST, IL 60305-1230
(708) 771-4528
Mailing address
7379 W NORTH AVE, RIVER FOREST, IL 60305-1230
(708) 771-4528
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
08/17/2006
Last updated
07/08/2007
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