Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 00018171 | AL |
N | 208600000X | Surgeon | 00018171 | AL |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 00018171 | AL |
NPI | 1265435382 |
---|---|
Provider Name | Dr. Kitti K Outlaw |
First Address | Mobile, AL 36608-1774 |
Second Address | Mobile, AL 36608-1774 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 04/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009937160 | (05) | AL |
51519924 | BC/BS (01) | AL |
F70487 | (02) | AL |