Basic Information
| Provider Information | |||||||||
| NPI: | 1346353315 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OUTLAW | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | MARCUS | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14883 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274154883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362746515 | ||||||||
| FaxNumber: | 3362750812 | ||||||||
| Practice Location | |||||||||
| Address1: | 1002 N CHURCH ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363780713 | ||||||||
| FaxNumber: | 3362739060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 200400933 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 199228 | 01 | NC | MEDCOST | OTHER | 810602 | 01 | NC | PARTNERS | OTHER | 3810009236 | 05 | WV | MEDICAID | Q0093E | 05 | SC | MEDICAID | 7409757 | 01 | AETNA | OTHER | 145JA | 01 | NC | BCBS | OTHER | 5904785 | 05 | NC | MEDICAID | 1346353315 | 05 | VA | MEDICAID | 7301538 | 01 | NC | CIGNA | OTHER |