Provider Demographics
NPI:1346353315
Name:OUTLAW, WILLIAM MARCUS (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARCUS
Last Name:OUTLAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-274-6515
Mailing Address - Fax:336-275-0812
Practice Address - Street 1:1002 N CHURCH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1439
Practice Address - Country:US
Practice Address - Phone:336-378-0713
Practice Address - Fax:336-273-9060
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200400933207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC199228OtherMEDCOST
NC810602OtherPARTNERS
WV3810009236Medicaid
SCQ0093EMedicaid
7409757OtherAETNA
NC145JAOtherBCBS
NC5904785Medicaid
VA1346353315Medicaid
NC7301538OtherCIGNA
7409757OtherAETNA
NCI19942Medicare UPIN