Individual
KEVIN BRADBURY OOTHOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
391 WALLACE RD, NASHVILLE, TN 37211-4851
(615) 781-4605
Mailing address
PO BOX 634706, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD024636
TN
Other
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
Enumeration date
06/03/2006
Last updated
11/12/2007
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