Healthcare Provider Details

I. General information

NPI: 1255322749
Provider Name (Legal Business Name): ERIC NEIL LITTLEFIELD MPAS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 W BOURNE CIR STE 200
FARMINGTON UT
84025-3657
US

IV. Provider business mailing address

444 W BOURNE CIR STE 200
FARMINGTON UT
84025-3657
US

V. Phone/Fax

Practice location:
  • Phone: 801-776-0174
  • Fax: 801-825-3904
Mailing address:
  • Phone: 801-397-3000
  • Fax: 801-397-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9287746-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberNCCPA 1049736
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: