Provider Demographics
NPI:1083368401
Name:LITTLE, GENE EDWARD JR
Entity Type:Individual
Prefix:MR
First Name:GENE
Middle Name:EDWARD
Last Name:LITTLE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 LITTLE RIVER CT
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3895
Mailing Address - Country:US
Mailing Address - Phone:214-679-7196
Mailing Address - Fax:
Practice Address - Street 1:1705 LITTLE RIVER CT
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3895
Practice Address - Country:US
Practice Address - Phone:214-679-7196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local