Provider Demographics
NPI:1619031051
Name:LITTLE, DANIEL JAMES (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:LITTLE
Suffix:
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 1:5044 N BARTON AVE
Mailing Address - Street 2:MS HC 81
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93740-0001
Mailing Address - Country:US
Mailing Address - Phone:559-278-6751
Mailing Address - Fax:559-278-7602
Practice Address - Street 1:5044 N BARTON AVE
Practice Address - Street 2:MS HC 81
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93740-0001
Practice Address - Country:US
Practice Address - Phone:559-278-6751
Practice Address - Fax:559-278-7602
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG72337OtherMEDICAL LICENSE
CAF59239Medicare UPIN
CA00G723371Medicare ID - Type UnspecifiedPPIN