Organization
BLAKE ALLEN LITTLE, M.D., L.L.C.
Active
Other names
Blake Allen Little, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA K QUALLS (MGMR)
(918) 510-0129
Entity
Organization
Contact information
Practice address
5612 E 117TH PL, TULSA, OK 74137
(918) 510-0129
(918) 296-5172
Mailing address
5612 E 117TH PL, TULSA, OK 74137-8528
(918) 510-0129
(918) 296-5172
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036-106221
IL
174400000X
Specialist
04-25029
KS
174400000X
Specialist
1170
MN
174400000X
Specialist
16264
OK
174400000X
Specialist
40672
TN
174400000X
Specialist
58363
GA
174400000X
Specialist
N-8113
AR
174400000X
Specialist
Primary
R4J98
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000205533
KS BLUE CROSS
KS
05
—
121409001
—
AR
01
—
150325
MO BLUE CROSS
MO
05
—
2050549604
—
KS
05
—
206894506
—
MO
01
—
55425
ARKANSAS BLUE CROSS
AR
01
—
7404
MO BLUE CROSS
MO
05
—
A4877801498
—
OK
Enumeration date
08/30/2006
Last updated
05/22/2018
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