Provider Demographics
NPI:1922006295
Name:OUTLAND, JAMES DAVID
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DAVID
Last Name:OUTLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:DAVID
Other - Last Name:OUTLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:300 S 8TH ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2400
Mailing Address - Country:US
Mailing Address - Phone:270-759-4500
Mailing Address - Fax:270-761-1879
Practice Address - Street 1:300 S 8TH ST
Practice Address - Street 2:SUITE 405
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2400
Practice Address - Country:US
Practice Address - Phone:270-759-4500
Practice Address - Fax:270-761-1879
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34234207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64032352Medicaid
KY1886701Medicare PIN
KY64032352Medicaid