Basic Information
| Provider Information | |||||||||
| NPI: | 1205807385 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LITTLE | ||||||||
| FirstName: | RANDALL | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 S JACKSON HWY | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | SHEFFIELD | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356605777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563818811 | ||||||||
| FaxNumber: | 2563815151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 09/30/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 10197 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 009954985 | 05 | AL | MEDICAID | 4088303 | 01 | TN | BCBS | OTHER | 510-49307 | 01 | AL | BCBS | OTHER | P00140874 | 01 | RAILROAD MEDICARE | OTHER | P00744568 | 01 | AL | RAILROAD MEDICARE | OTHER | 515-21837 | 01 | AL | BCBS | OTHER | 112762 | 05 | AL | MEDICAID | 25-10137 | 01 | UNITED HEALTHCARE | OTHER | 112766 | 05 | AL | MEDICAID | 112768 | 05 | AL | MEDICAID | 4306519 | 01 | AETNA | OTHER | 510-49318 | 01 | AL | BCBS | OTHER | 510-49462 | 01 | AL | BCBS | OTHER | 07776571 | 05 | MS | MEDICAID |