Provider Demographics
NPI:1356538961
Name:KITTI K. OUTLAW, M.D., P.C.
Entity type:Organization
Organization Name:KITTI K. OUTLAW, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KITTI
Authorized Official - Middle Name:K
Authorized Official - Last Name:OUTLAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-414-1333
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:251-414-3006
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:251-414-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000181712086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL46679OtherHEALTHSPRING
AL051519924OtherBLUE CROSS BLUE SHIELD
1710551OtherUNITEDHEALTH CARE
AL0005234470OtherAETNA
AL009937160Medicaid
AL1310551OtherSECURE HORIZONS
AL1310551OtherSECURE HORIZONS
AL=========OtherTRICARE
AL=========OtherTRICARE