Provider Demographics
NPI:1578629036
Name:OUTEN, RONNIE BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:BRIAN
Last Name:OUTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 E WOOD ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4421
Mailing Address - Country:US
Mailing Address - Phone:731-642-2011
Mailing Address - Fax:731-644-2758
Practice Address - Street 1:1323 E WOOD ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4421
Practice Address - Country:US
Practice Address - Phone:731-642-2011
Practice Address - Fax:731-644-2758
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900973174400000X
TNMD45720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH51565Medicare UPIN