Healthcare Provider Details

I. General information

NPI: 1801909122
Provider Name (Legal Business Name): DAVID BRADLEY BECKSTEAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 NORTH 1 EAST
PRESTON ID
83263
US

IV. Provider business mailing address

41 NORTH 1 EAST
PRESTON ID
83263
US

V. Phone/Fax

Practice location:
  • Phone: 208-852-3851
  • Fax: 208-852-3856
Mailing address:
  • Phone: 208-852-3851
  • Fax: 208-852-3856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM5211
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: