Healthcare Provider Details

I. General information

NPI: 1972587145
Provider Name (Legal Business Name): ROBERT DAVID BECK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COWLES ST
FAIRBANKS AK
99701-5925
US

IV. Provider business mailing address

3001 WIDGEON LN STE 5
ANCHORAGE AK
99508-4617
US

V. Phone/Fax

Practice location:
  • Phone: 907-458-5525
  • Fax: 907-458-5514
Mailing address:
  • Phone: 907-230-0896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4025
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: