Healthcare Provider Details

I. General information

NPI: 1477905156
Provider Name (Legal Business Name): WILLIAM KEITH BECKMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

846 LAKE HOWELL RD
MAITLAND FL
32751-5222
US

IV. Provider business mailing address

846 LAKE HOWELL RD
MAITLAND FL
32751-5222
US

V. Phone/Fax

Practice location:
  • Phone: 407-767-2477
  • Fax: 407-767-1627
Mailing address:
  • Phone: 407-767-2477
  • Fax: 407-767-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS14263
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: