MEDICARE: RUSSELL W BECKER D.O.

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	2086S0129X	Vascular Surgery Physician	OS12827	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16508	OTHER	MI	M-CARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710957485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL W BECKER D.O.

Provider Business Mailing Address
First Line	:	1875 VETERANS PARK DR STE 2203
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-0596
Country	:	US
Telephone Number	:	239-431-5884
Fax Number	:	239-631-6907

Provider Business Practice Location Address
First Line	:	1875 VETERANS PARK DR STE 2203
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-0596
Country	:	US
Telephone Number	:	239-431-5884
Fax Number	:	239-631-6907

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	09/22/2020

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