MEDICARE: MR. GENE EDWARD LITTLE JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP0905X	State or Local Public Health Clinic/Center

General Provider Information

NPI Number	:	1083368401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GENE EDWARD LITTLE JR.

Provider Business Mailing Address
First Line	:	1705 LITTLE RIVER CT
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-3895
Country	:	US
Telephone Number	:	214-679-7196
Fax Number	:

Provider Business Practice Location Address
First Line	:	1705 LITTLE RIVER CT
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-3895
Country	:	US
Telephone Number	:	214-679-7196
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2022
Last Update Date	:	02/04/2022

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Directions to “ MR. GENE EDWARD LITTLE JR. ” Practice Location

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