Individual
TERRY M LITTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4750 N FIVE MILE RD, BOISE, ID 83713-2715
(208) 375-0500
(208) 375-4310
Mailing address
4750 N FIVE MILE RD, BOISE, ID 83713-2715
(208) 375-0500
(208) 375-4310
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-53
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010000238
BLUE SHIELD
ID
01
—
000010152070
BLUE SHIELD
ID
05
—
004313500
—
ID
01
—
J3698
BLUE CROSS
ID
01
—
S5258
BLUE CROSS
ID
Enumeration date
08/21/2006
Last updated
10/14/2008
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