Provider Demographics
NPI:1013913219
Name:OUTLAW, DAVID THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:THOMAS
Last Name:OUTLAW
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 1:224 HIGH HOUSE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4278
Mailing Address - Country:US
Mailing Address - Phone:919-380-7531
Mailing Address - Fax:919-380-0686
Practice Address - Street 1:224 HIGH HOUSE RD
Practice Address - Street 2:STE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-4278
Practice Address - Country:US
Practice Address - Phone:919-380-7531
Practice Address - Fax:919-380-0686
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000289208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126GWMedicaid
NC2280263AMedicare ID - Type UnspecifiedPROVIDER NUMBER
NC89126GWMedicaid