Individual provider · NPI-1
Julian Keith Little
Military Health Care Provider, Independent Duty Medical Technicians · Mountain Home, ID
NPI number1447480686
StatusActive
Last updated in NPPESJul 22, 2009
Details
- NPI
- 1447480686
- Entity type
- Individual (NPI-1)
- Name
- Mr. Julian Keith Little
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 22, 2009
- Last updated
- Jul 22, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1710I1003X | Military Health Care Provider, Independent Duty Medical Technicians | – | – | Yes |
Practice location
Mountain Home Afb90 Hope Dr. Bldg 6000/366 Med Gp/Amds/Sgpf
Mountain Home, ID 83648
Phone 208-828-7401
Mailing address
1285 Owyhee CtMountain Home, ID 83647-1925
Phone 208-590-4890
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