Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 01055917A | IN |
N | 2080P0204X | Pediatric Emergency Doctor | 01055917A | IN |
NPI | 1326026667 |
---|---|
Provider Name | Jason Dewitt Little |
First Address | Indianapolis, IN 46290-1024 |
Second Address | Indianapolis, IN 46260-1902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 19/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H66367 | (02) |