MEDICARE: OUTLAW MEDICAL ARTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	16787	CO

General Provider Information

NPI Number	:	1134667934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUTLAW MEDICAL ARTS LLC

Provider Business Mailing Address
First Line	:	220 EAST AVE
Second Line	:
City	:	RIFLE
State	:	CO
Zip	:	81650-2332
Country	:	US
Telephone Number	:	970-625-5521
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 EAST AVE
Second Line	:
City	:	RIFLE
State	:	CO
Zip	:	81650-2332
Country	:	US
Telephone Number	:	970-625-5521
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GEORGE THOMAS MORTON
Credential	:	MD
Telephone Number	:	970-625-5521

Provider Enumeration Date	:	02/01/2017
Last Update Date	:	02/01/2017

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