Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 0773 | AZ |
NPI | 1093125726 |
---|---|
Provider Name | Dr. Mark Little |
First Address | Chandler, AZ 85249-4742 |
Second Address | Chandler, AZ 85249-4742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2014 |
Last Update Date | 02/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0773 | ARIZONA STATE BOARD OF PODIATRY (01) | AZ |