Outlaw, Edward Michael

Outlaw, Edward Michael is an individual health care provider with primary practice located at 4505 Precissi Ln Ste A , Stockton CA 95207-6240. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Interventional Pain Medicine, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Outlaw, Edward Michael can be contacted via phone (209) 425-3815.

Contact Information

Primary practice address
4505 Precissi Ln Ste A Stockton CA 95207-6240
Phone: (209) 425-3815
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X 10630 Nevada
Allopathic & Osteopathic Physicians / Pain Medicine 2081P2900X 10630 Nevada

Profile Details

NPI number 1891792743
LBN Legal business name Outlaw, Edward Michael
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2005
Last updated Jun 30th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891792743 NPPES
Nevada MEDICAID 100500786

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