Healthcare Provider Details

I. General information

NPI: 1124162789
Provider Name (Legal Business Name): EDWARD HENRY GEORGE BECKER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13837 CIRCA CROSSING DR
LITHIA FL
33547-4382
US

IV. Provider business mailing address

13837 CIRCA CROSSING DR
LITHIA FL
33547-4382
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-2663
  • Fax: 813-685-6222
Mailing address:
  • Phone: 813-684-2663
  • Fax: 813-685-9178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME116897
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME 116897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: