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NPI Code Detail

MEDICARE: JOHN BECKMANN

MEDICARE: JOHN BECKMANN
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1710603634
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN BECKMANN
Provider Business Mailing Address
First Line : 118 W KEETOOWAH ST
Second Line :
City : TAHLEQUAH
State : OK
Zip : 74464-3820
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 118 W KEETOOWAH ST
Second Line :
City : TAHLEQUAH
State : OK
Zip : 74464-3820
Country : US
Telephone Number : 918-708-9474
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2022
Last Update Date : 10/12/2022

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