Healthcare Provider Details

I. General information

NPI: 1639192578
Provider Name (Legal Business Name): CAROL PRATT BECKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 E PRUDHOMME ST
OPELOUSAS LA
70570-6499
US

IV. Provider business mailing address

21 VERSAILLES BLVD
NEW ORLEANS LA
70125-4113
US

V. Phone/Fax

Practice location:
  • Phone: 337-942-6883
  • Fax: 337-942-6883
Mailing address:
  • Phone: 504-866-4115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberJ7427
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD.019009
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: