Provider Demographics
NPI:1144223181
Name:LITTLE, EUGENE R JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:R
Last Name:LITTLE
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:ST MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2447
Mailing Address - Country:US
Mailing Address - Phone:419-394-8664
Mailing Address - Fax:419-394-1148
Practice Address - Street 1:1013 E SPRING ST
Practice Address - Street 2:
Practice Address - City:ST MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2447
Practice Address - Country:US
Practice Address - Phone:419-394-8664
Practice Address - Fax:419-394-1148
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2287-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH480004481OtherMEDICARE RAILROAD
OH0601816Medicaid
OH0573214Medicare PIN
OH1128890001Medicare NSC
OH480004481OtherMEDICARE RAILROAD
OH0573212Medicare PIN
OH0573215Medicare PIN