Healthcare Provider Details

I. General information

NPI: 1639128838
Provider Name (Legal Business Name): PETER D LITTLEFIELD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3449 LYNNSHIRE DR
BIRMINGHAM AL
35216-5215
US

IV. Provider business mailing address

3449 LYNNSHIRE DR
BIRMINGHAM AL
35216-5215
US

V. Phone/Fax

Practice location:
  • Phone: 205-979-0235
  • Fax:
Mailing address:
  • Phone: 205-979-0235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA34
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA-34
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: