Provider Demographics
NPI:1073566618
Name:OUTWATER, DEBORAH L (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:OUTWATER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N CARRIAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4508
Mailing Address - Country:US
Mailing Address - Phone:316-858-5800
Mailing Address - Fax:316-858-5850
Practice Address - Street 1:800 N CARRIAGE PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4508
Practice Address - Country:US
Practice Address - Phone:316-858-5800
Practice Address - Fax:316-858-5850
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS665231OtherFIRSTGUARD
KS100340970BMedicaid
KS103245OtherBCBS O F KANSAS
KS103245Medicare ID - Type Unspecified
KS100340970BMedicaid
189082Medicare PIN