Healthcare Provider Details

I. General information

NPI: 1215010210
Provider Name (Legal Business Name): BARRY MEADE LITTLEJOHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E EVERGREEN ST
CAMERON MO
64429-2400
US

IV. Provider business mailing address

1600 E EVERGREEN ST
CAMERON MO
64429-2400
US

V. Phone/Fax

Practice location:
  • Phone: 816-632-2100
  • Fax: 816-632-6123
Mailing address:
  • Phone: 816-632-2100
  • Fax: 816-632-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036071363
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number37577
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2019046561
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: