Healthcare Provider Details

I. General information

NPI: 1750367546
Provider Name (Legal Business Name): MARK JOHN BECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N HIGHLAND SPRINGS AVE
BANNING CA
92220-3046
US

IV. Provider business mailing address

600 N HIGHLAND SPRINGS AVE
BANNING CA
92220-3046
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-1121
  • Fax:
Mailing address:
  • Phone: 805-578-8300
  • Fax: 805-578-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberG27503
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberG27503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: