Individual
MICHAEL STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
700 LILLY RD NE, OLYMPIA, WA 98506-5115
(360) 923-7000
Mailing address
700 LILLY RD NE, OLYMPIA, WA 98506-5115
(360) 923-7000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E1208
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120616
UNITED HEALTHCARE
AR
05
—
134672001
—
AR
01
—
18141000000
QUALCHOICE
AR
01
—
5K845
BLUE CROSS BLUE SHIELD
AR
Enumeration date
08/23/2005
Last updated
05/04/2021
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