MEDICARE: MARC SHAWN LITLE M.D.

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	2084P0800X	Psychiatry Physician	J3344	TX

General Provider Information

NPI Number	:	1710009105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC SHAWN LITLE M.D.

Provider Business Mailing Address
First Line	:	5944 LUTHER LANE
Second Line	:	STE. 800
City	:	DALLAS
State	:	TX
Zip	:	75225-5523
Country	:	US
Telephone Number	:	214-361-8384
Fax Number	:	214-361-8454

Provider Business Practice Location Address
First Line	:	5944 LUTHER LANE
Second Line	:	STE. 800
City	:	DALLAS
State	:	TX
Zip	:	75225-5523
Country	:	US
Telephone Number	:	214-361-8384
Fax Number	:	214-361-8454

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	09/10/2010

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