Provider Demographics
NPI:1265435382
Name:OUTLAW, KITTI K (MD)
Entity type:Individual
Prefix:DR
First Name:KITTI
Middle Name:K
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 1:3715 DAUPHIN ST STE 6A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1774
Mailing Address - Country:US
Mailing Address - Phone:251-414-1333
Mailing Address - Fax:351-414-3006
Practice Address - Street 1:3715 DAUPHIN ST STE 6A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1774
Practice Address - Country:US
Practice Address - Phone:251-414-1333
Practice Address - Fax:351-414-3006
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2019-03-04
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
AL000181712086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51519924OtherBC/BS
AL009937160Medicaid
AL009937160Medicaid
AL51519924OtherBC/BS