Provider Demographics
NPI:1821199274
Name:JOHN THOMAS LITTELL,M.D.,P.A.
Entity Type:Organization
Organization Name:JOHN THOMAS LITTELL,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LITTELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:407-343-1711
Mailing Address - Street 1:300 PARK PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2325
Mailing Address - Country:US
Mailing Address - Phone:407-343-1711
Mailing Address - Fax:407-343-1611
Practice Address - Street 1:300 PARK PLACE BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2325
Practice Address - Country:US
Practice Address - Phone:407-343-1711
Practice Address - Fax:407-343-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76131207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256228600Medicaid
FLF72693Medicare UPIN
FL256228600Medicaid