Healthcare Provider Details

I. General information

NPI: 1497827802
Provider Name (Legal Business Name): RICHARD LOWE BECK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N MAITLAND AVENUE
ALTAMONTE SPRINGS FL
32701
US

IV. Provider business mailing address

311 N MAITLAND AVENUE
ALTAMONTE SPRINGS FL
32701
US

V. Phone/Fax

Practice location:
  • Phone: 407-834-0003
  • Fax: 407-831-5765
Mailing address:
  • Phone: 407-834-0003
  • Fax: 407-831-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME0008293
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number14738
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: