Basic Information
| Provider Information | |||||||||
| NPI: | 1770537441 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | STOUT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | TIMOTHY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6565 FANNIN STREET, NC205 | ||||||||
| Address2: | BAYLOR COLLEGE OF MEDICINE, DEPARTMENT OF OPHTHALMOLOGY | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137985951 | ||||||||
| FaxNumber: | 7137984364 | ||||||||
| Practice Location | |||||||||
| Address1: | 1977 BUTLER BLVD | ||||||||
| Address2: | ALKEK EYE CENTER | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137986100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | P8623 | TX | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 335344307 | 05 | TX | MEDICAID |