Healthcare Provider Details

I. General information

NPI: 1508009135
Provider Name (Legal Business Name): SAMUEL BECKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 PALM BEACH LAKES BLVD
WEST PALM BEACH FL
33409-6501
US

IV. Provider business mailing address

2007 PALM BEACH LAKES BLVD
WEST PALM BEACH FL
33409-6501
US

V. Phone/Fax

Practice location:
  • Phone: 561-420-8555
  • Fax: 561-420-8550
Mailing address:
  • Phone: 561-420-8555
  • Fax: 561-420-8550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ1570
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME117064
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: