Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 41316 | KY |
NPI | 1023166139 |
---|---|
Provider Name | Dr. Jarrod Alexander Little |
First Address | Louisville, KY 40202-5700 |
Second Address | Louisville, KY 40202-5700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 22/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200942680 | (05) | IN |
3704983000 | PASSPORT ADVANTAGE (01) | KY |
50023218 | PASSPORT (01) | KY |
64104862 | (05) | KY |