Healthcare Provider Details

I. General information

NPI: 1356359830
Provider Name (Legal Business Name): JOHN CLETUS BECKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL DR #7
MT VIEW CA
94040
US

IV. Provider business mailing address

2500 HOSPITAL DR #7
MT VIEW CA
94040
US

V. Phone/Fax

Practice location:
  • Phone: 650-968-7118
  • Fax: 408-732-0374
Mailing address:
  • Phone: 650-968-7118
  • Fax: 408-732-0374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG17632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: