Healthcare Provider Details

I. General information

NPI: 1013914332
Provider Name (Legal Business Name): GERALD J BECKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/14/2024
Certification Date: 07/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 WEBBS CV
OSPREY FL
34229-9269
US

IV. Provider business mailing address

425 WEBBS CV
OSPREY FL
34229-9269
US

V. Phone/Fax

Practice location:
  • Phone: 860-549-3210
  • Fax:
Mailing address:
  • Phone: 860-416-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number024896
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: