Healthcare Provider Details

I. General information

NPI: 1780779199
Provider Name (Legal Business Name): ERNEST ALAN LITTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 LOUISIANA AVE
SHREVEPORT LA
71101-3910
US

IV. Provider business mailing address

1202 LOUISIANA AVE
SHREVEPORT LA
71101-3910
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-8977
  • Fax: 318-212-4153
Mailing address:
  • Phone: 318-212-8977
  • Fax: 318-212-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number38290
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: