Provider Demographics
NPI:1629243860
Name:J DAVID OUTLAND, M.D.
Entity Type:Organization
Organization Name:J DAVID OUTLAND, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:OUTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-759-4500
Mailing Address - Street 1:300 S 8TH ST STE 405E
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2444
Mailing Address - Country:US
Mailing Address - Phone:270-759-4500
Mailing Address - Fax:270-761-1879
Practice Address - Street 1:300 S 8TH ST STE 405E
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2444
Practice Address - Country:US
Practice Address - Phone:270-759-4500
Practice Address - Fax:270-761-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34234207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty