Individual
MICHAEL G OUTSLAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1730 PRAIRIE CITY ROAD, SUITE 120, FOLSOM, CA 95630
(916) 351-4800
(916) 351-4899
Mailing address
3400 DATA DR, CREDENTIALING, RANCHO CORDOVA, CA 95670-7956
(916) 379-2948
(916) 858-7065
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
PA20935
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4292600001
DME SUPPLIER NUMBER
CA
Enumeration date
06/24/2005
Last updated
10/25/2022
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