MEDICARE: JERALD J. LITTLEFIELD, M.D., P.C.

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	207W00000X	Ophthalmology Physician	NM92284	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180043909	OTHER		RR MEDICARE

General Provider Information

NPI Number	:	1912038118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERALD J. LITTLEFIELD, M.D., P.C.

Provider Business Mailing Address
First Line	:	2100 CALLE DE LA VUELTA STE E-104
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4742
Country	:	US
Telephone Number	:	505-982-8831
Fax Number	:	505-983-2763

Provider Business Practice Location Address
First Line	:	2100 CALLE DE LA VUELTA STE E-104
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4742
Country	:	US
Telephone Number	:	505-982-8831
Fax Number	:	505-983-2763

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	JERALD J. LITTLEFIELD
Credential	:
Telephone Number	:	505-982-8831

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	05/05/2010

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