Provider Demographics
NPI:1457372047
Name:EDWARD OUTLAW, MD, PC
Entity Type:Organization
Organization Name:EDWARD OUTLAW, MD, PC
Other - Org Name:DESERT PEAK REHALBILITATION & PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:OUTLAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-592-0713
Mailing Address - Street 1:9280 W SUNSET RD
Mailing Address - Street 2:SUITE #412
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4860
Mailing Address - Country:US
Mailing Address - Phone:702-592-0713
Mailing Address - Fax:
Practice Address - Street 1:9280 W SUNSET RD
Practice Address - Street 2:SUITE #412
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4860
Practice Address - Country:US
Practice Address - Phone:702-592-0713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106302081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty