Healthcare Provider Details

I. General information

NPI: 1164573739
Provider Name (Legal Business Name): BRADLEY GERARD BECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

12340 HERRING RD
COLORADO SPRINGS CO
80908-4194
US

IV. Provider business mailing address

12340 HERRING RD
COLORADO SPRINGS CO
80908-4194
US

V. Phone/Fax

Practice location:
  • Phone: 719-238-6672
  • Fax:
Mailing address:
  • Phone: 719-238-6672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35672
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: