MEDICARE: DR. EUGENE R LITTLE JR. D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	36-00-2287-L	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480004481	OTHER	OH	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144223181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE R LITTLE JR. D.P.M.

Provider Business Mailing Address
First Line	:	1013 E SPRING ST
Second Line	:
City	:	ST MARYS
State	:	OH
Zip	:	45885-2447
Country	:	US
Telephone Number	:	419-394-8664
Fax Number	:	419-394-1148

Provider Business Practice Location Address
First Line	:	1013 E SPRING ST
Second Line	:
City	:	ST MARYS
State	:	OH
Zip	:	45885-2447
Country	:	US
Telephone Number	:	419-394-8664
Fax Number	:	419-394-1148

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	12/15/2009

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Directions to “ DR. EUGENE R LITTLE JR. D.P.M.” Practice Location

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