Individual
JACOB STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2472 S 300 E, SOUTH SALT LAKE, UT 84115-2895
(801) 783-5011
Mailing address
1118 MOYLE DR, ALPINE, UT 84004-1200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13593511-1206
UT
Other
Enumeration date
08/01/2022
Last updated
11/01/2023
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