Provider Demographics
NPI:1285628941
Name:LITTRELL, J. SCOTT (DPM)
Entity Type:Individual
Prefix:MR
First Name:J.
Middle Name:SCOTT
Last Name:LITTRELL
Suffix:
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 1:2204 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-1019
Mailing Address - Country:US
Mailing Address - Phone:254-754-1811
Mailing Address - Fax:254-754-1960
Practice Address - Street 1:2204 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1019
Practice Address - Country:US
Practice Address - Phone:254-754-1811
Practice Address - Fax:254-754-1960
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0480213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00836901Medicaid
TX00836901Medicaid
TX00N984Medicare ID - Type Unspecified