MEDICARE: PERRY K. BECKSTROM, DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	L9622	TX

General Provider Information

NPI Number	:	1003019555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERRY K. BECKSTROM, DO

Provider Business Mailing Address
First Line	:	3946 S BUCKNER BLVD STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-4313
Country	:	US
Telephone Number	:	214-381-7194
Fax Number	:	214-381-7195

Provider Business Practice Location Address
First Line	:	3946 S BUCKNER BLVD STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-4313
Country	:	US
Telephone Number	:	214-381-7194
Fax Number	:	214-381-7195

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. PERRYK KENT BECKSTROM
Credential	:	DO
Telephone Number	:	214-381-7194

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	09/17/2008

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