Provider Demographics
NPI:1639137342
Name:LITTLE, DARREN J (MD)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:J
Last Name:LITTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 84642
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5942
Mailing Address - Country:US
Mailing Address - Phone:425-297-5590
Mailing Address - Fax:425-297-5595
Practice Address - Street 1:1717 13TH ST STE 200
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1621
Practice Address - Country:US
Practice Address - Phone:425-297-5597
Practice Address - Fax:425-297-5598
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
WAMD000436062085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8400970Medicaid
WA8400970Medicaid
WAG8805407Medicare PIN