Provider Demographics
NPI:1124083357
Name:LITTON, FREDERICK MITCHELL (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:MITCHELL
Last Name:LITTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 OLD STAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620
Mailing Address - Country:US
Mailing Address - Phone:423-844-0536
Mailing Address - Fax:
Practice Address - Street 1:237 OLD STAGE DRIVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-230-2420
Practice Address - Fax:423-230-2422
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD38139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPENDINGMedicaid
TNB05993Medicare UPIN
TNPENDINGMedicaid