MEDICARE: ROGER ALLAN 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	207R00000X	Internal Medicine Physician	D1545	TX
2	2083A0100X	Aerospace Medicine Physician	D1545	TX

General Provider Information

NPI Number	:	1588926026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER ALLAN BECK M.D.

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

Provider Business Practice Location Address
First Line	:	4509 FOX FIRE WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133
Country	:	US
Telephone Number	:	480-560-7531
Fax Number	:

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

Provider Enumeration Date	:	06/11/2012
Last Update Date	:	06/11/2012

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