MEDICARE: DR. PAUL BECK M.D.

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD00024219	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	601 314 648	OTHER	WA	UBI NUMBER
2	1030715	OTHER	WA	DSHS PROVIDER NUMBER

General Provider Information

NPI Number	:	1376619171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL BECK M.D.

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

Provider Business Practice Location Address
First Line	:	1620 43RD AVE E
Second Line	:	#4B
City	:	SEATTLE
State	:	WA
Zip	:	98112-3266
Country	:	US
Telephone Number	:	206-618-7729
Fax Number	:	206-325-0366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	11/19/2011

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