Healthcare Provider Details

I. General information

NPI: 1982191722
Provider Name (Legal Business Name): MICHAEL DAVID BECKMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 BLOSSOM HILL RD STE 10
SAN JOSE CA
95124-6350
US

IV. Provider business mailing address

1604 BLOSSOM HILL RD STE 10
SAN JOSE CA
95124-6350
US

V. Phone/Fax

Practice location:
  • Phone: 408-528-8833
  • Fax:
Mailing address:
  • Phone: 408-528-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA175183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: