Provider Demographics
NPI:1417935354
Name:LITTLE, JOHN WESLEY III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WESLEY
Last Name:LITTLE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19020 33RD AVE W
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4746
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4746
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1374
Is Sole Proprietor?:No
Enumeration Date:2006-01-01
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000184462085R0202X
IDM-123082085R0202X
AKS-61582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA115851OtherL&I PROVIDER NUMBER
WA155477OtherL&I PROVIDER NUMBER
WA8270407Medicaid
WA175558OtherL&I PROVIDER NUMBER
WA204110OtherL & I PROVIDER NUMBER
ID1417935354Medicaid
AK1584948Medicaid
WA8270407Medicaid
WA204110OtherL & I PROVIDER NUMBER
WAGAB02906Medicare PIN
ID20004419Medicare PIN
WA155477OtherL&I PROVIDER NUMBER
WAP00368468Medicare PIN
WAGAB25174Medicare PIN
WAG8872040Medicare PIN
WAP00932788Medicare PIN
WA300126019Medicare PIN
WAG8857934Medicare PIN
WA175558OtherL&I PROVIDER NUMBER
WA300076701Medicare PIN
WA8862852Medicare PIN