Provider Demographics
NPI:1467867358
Name:LITTLEFIELD, JOHN PEDER (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PEDER
Last Name:LITTLEFIELD
Suffix:
Gender:M
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:1905 E HUEBBE PKWY
Mailing Address - Street 2:BELOIT HEALTH SYSTEM INC
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2230
Mailing Address - Fax:608-363-7374
Practice Address - Street 1:1905 E HUEBBE PKWY
Practice Address - Street 2:BELOIT HEALTH SYSTEM INC
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1842
Practice Address - Country:US
Practice Address - Phone:608-364-2230
Practice Address - Fax:608-363-7374
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085-005209363A00000X
WI3474-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant