Healthcare Provider Details

I. General information

NPI: 1457372047
Provider Name (Legal Business Name): EDWARD OUTLAW, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9280 W SUNSET RD SUITE #412
LAS VEGAS NV
89148-4860
US

IV. Provider business mailing address

9280 W SUNSET RD SUITE #412
LAS VEGAS NV
89148-4860
US

V. Phone/Fax

Practice location:
  • Phone: 702-592-0713
  • Fax:
Mailing address:
  • Phone: 702-592-0713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number10630
License Number StateNV

VIII. Authorized Official

Name: DR. EDWARD MICHAEL OUTLAW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 702-592-0713