Individual
KENNETH M LITTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
190 E BANNOCK ST, 10TH FLOOR, BOISE, ID 83712-6241
(208) 381-5500
(208) 381-2555
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
(208) 367-2968
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
M8861
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010152057
REGENCE BLUE SHIELD
—
01
—
0203233
WA DEPARTMENT OF LABOR
WA
01
—
269560
OMAP
OR
01
—
610978600
US DEPARTMENT OF LABOR
—
01
—
74906
BLUE CROSS OF IDAHO
ID
05
—
807732400
—
ID
05
—
860902000
—
ID
01
—
8J190
BLUE CROSS OF IDAHO GROUP
ID
Enumeration date
07/21/2006
Last updated
12/29/2012
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