MEDICARE: EDWARD OUTLAW, MD, PC

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	10630	NV

General Provider Information

NPI Number	:	1457372047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD OUTLAW, MD, PC

Provider Business Mailing Address
First Line	:	9280 W SUNSET RD
Second Line	:	SUITE #412
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4860
Country	:	US
Telephone Number	:	702-592-0713
Fax Number	:

Provider Business Practice Location Address
First Line	:	9280 W SUNSET RD
Second Line	:	SUITE #412
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4860
Country	:	US
Telephone Number	:	702-592-0713
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD MICHAEL OUTLAW
Credential	:	M.D.
Telephone Number	:	702-592-0713

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/22/2020

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