Provider Demographics
NPI:1639128838
Name:LITTLEFIELD, PETER D (PA)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:D
Last Name:LITTLEFIELD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3449 LYNNSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-5215
Mailing Address - Country:US
Mailing Address - Phone:205-979-0235
Mailing Address - Fax:
Practice Address - Street 1:3449 LYNNSHIRE DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-5215
Practice Address - Country:US
Practice Address - Phone:205-979-0235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA34363A00000X
ALPA-34363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51043996OtherBCBS
S02814Medicare UPIN
AL510439964TMedicare ID - Type Unspecified