# KEVIN BRADBURY OOTHOUT

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1538107206
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | MD024636 | TN | Yes |

## Other

- **Enumeration date:** 06/03/2006
- **Last updated:** 11/12/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3122698 | BLUE CROSS | TN |
| 01 | — | 33323 | TLC TENNCARE | TN |
| 05 | — | 3746649 | — | TN |
| 05 | — | 3846640 | — | TN |
| 05 | — | 3846641 | — | TN |
| 01 | — | 4079134 | BLUE CROSS | TN |
| 01 | — | 4079137 | BLUE CROSS | TN |
| 01 | — | 41242 | TLC TENNCARE | TN |
| 01 | — | P00208403 | MEDICARE RAILROAD | TN |
| 01 | — | P00222460 | MEDICARE RAILROAD | TN |