Healthcare Provider Details

I. General information

NPI: 1114120474
Provider Name (Legal Business Name): JASON D. BECK M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 S ELM AVE
FRESNO CA
93706-5435
US

IV. Provider business mailing address

7001 HIGHWAY 614
MOSS POINT MS
39562
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-5200
  • Fax: 559-457-5296
Mailing address:
  • Phone: 228-588-6622
  • Fax: 228-588-9399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21210
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC135430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: