=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285628941
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | J. SCOTT LITTRELL DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2005
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2204 WASHINGTON AVE
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76701-1019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-754-1811
-----------------------------------------------------
Fax | 254-754-1960
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2204 WASHINGTON AVE
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76701-1019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-754-1811
-----------------------------------------------------
Fax | 254-754-1960
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 0480
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | 0480
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------