Individual
BRYAN CLIFTON STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7531 S STONY ISLAND AVE, CHICAGO, IL 60649-3954
(773) 947-7500
Mailing address
7531 S STONY ISLAND AVE, CHICAGO, IL 60649-3954
(773) 947-7500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003977
IL
363A00000X
Physician Assistant
10001402A
IN
Other
Enumeration date
02/23/2011
Last updated
04/05/2022
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