Provider Demographics
NPI:1164827135
Name:LITTLE, MARK STEVEN (IDC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:LITTLE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3RD MARINE DIVISION
Mailing Address - Street 2:
Mailing Address - City:OKINAWA
Mailing Address - State:OKINAWA
Mailing Address - Zip Code:9042171
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3D MARINE DIVISION
Practice Address - Street 2:UNIT 35801
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96382-5801
Practice Address - Country:US
Practice Address - Phone:949-767-7948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider