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General NPI Number Information
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NPI Number | 1952393845
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Entity Type | Individual
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Provider Name | MICHAEL JACKSON LITTLE MD
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Gender | Male
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 5974 PENTZ RD FEATHER RIVER HOSPITAL - CANYON VIEW CLINIC
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City | PARADISE
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State | CA
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Zip | 95969-5509
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Country | US
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Telephone | 530-872-2000
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Fax | 530-876-2164
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Provider Business Mailing Address
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Address Line | 321 BURDEN TER
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City | PARADISE
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State | CA
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Zip | 95969-5710
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Country | US
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Telephone | 530-872-1035
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Fax | 360-678-1346
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD00038113
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G34022
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License Number State | CA
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