Healthcare Provider Details

I. General information

NPI: 1922006295
Provider Name (Legal Business Name): DR. JAMES DAVID OUTLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAMES DAVID OUTLAND MD

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 8TH ST SUITE 405
MURRAY KY
42071-2400
US

IV. Provider business mailing address

300 S 8TH ST SUITE 405
MURRAY KY
42071-2400
US

V. Phone/Fax

Practice location:
  • Phone: 270-759-4500
  • Fax: 270-761-1879
Mailing address:
  • Phone: 270-759-4500
  • Fax: 270-761-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number34234
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: