Provider Demographics
NPI:1376588145
Name:LITTLETON, HERBERT ROSCOE (DO)
Entity Type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:ROSCOE
Last Name:LITTLETON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1500 E DOWNING ST
Mailing Address - Street 2:STE 103
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464
Mailing Address - Country:US
Mailing Address - Phone:918-456-0001
Mailing Address - Fax:918-456-6383
Practice Address - Street 1:1500 E DOWNING ST
Practice Address - Street 2:STE 103
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-456-0001
Practice Address - Fax:918-456-6383
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1756207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
060020996OtherRAILROAD MEDICARE
OK100734730AMedicaid
731117836001OtherBCBS
OK100144940AMedicaid
060020996OtherRAILROAD MEDICARE