1588926026 NPI number — ROGER ALLAN BECK M.D.

Table of content: ROGER ALLAN BECK M.D. (NPI 1588926026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588926026 NPI number — ROGER ALLAN BECK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECK
Provider First Name:
ROGER
Provider Middle Name:
ALLAN
Provider Name Prefix Text:
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:
BECK
Provider Other First Name:
ROGER
Provider Other Middle Name:
ALLAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1588926026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6017 E. WILSHIRE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85257-1957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-560-7531
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4509 FOX FIRE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-560-7531
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2012

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: 207R00000X , with the licence number:  D1545 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2083A0100X , with the licence number: D1545 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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