1376619171 NPI number — DR. PAUL BECK M.D.

Table of content: DR. PAUL BECK M.D. (NPI 1376619171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376619171 NPI number — DR. PAUL BECK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECK
Provider First Name:
PAUL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376619171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4515 MARTIN LUTHER KING JR WAY S
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98108-2182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-320-5325
Provider Business Mailing Address Fax Number:
206-320-5326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1620 43RD AVE E
Provider Second Line Business Practice Location Address:
#4B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-3266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-618-7729
Provider Business Practice Location Address Fax Number:
206-325-0366
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  MD00024219 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 601 314 648 . This is a "UBI NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1030715 . This is a "DSHS PROVIDER NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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