Provider Demographics
NPI:1558313502
Name:LITTLETON, JOHN R (PAC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:LITTLETON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2060
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-2060
Mailing Address - Country:US
Mailing Address - Phone:808-323-3107
Mailing Address - Fax:808-323-0012
Practice Address - Street 1:81-6587 MAMALAHOA HIGHWAY
Practice Address - Street 2:SUITE C-201
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750
Practice Address - Country:US
Practice Address - Phone:808-323-3107
Practice Address - Fax:808-323-0012
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-415363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIAMD-415OtherHAWAII STATE LICENCE
CAPA11933OtherSTATE LICENSE
CAML0534811OtherDEA
CAML0534811OtherDEA