Healthcare Provider Details

I. General information

NPI: 1578500542
Provider Name (Legal Business Name): JASON RICHARD BECKROW DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HALL ST SW STE 263
GRAND RAPIDS MI
49503-4988
US

IV. Provider business mailing address

401 HALL ST SW
GRAND RAPIDS MI
49503-5098
US

V. Phone/Fax

Practice location:
  • Phone: 616-719-0919
  • Fax: 616-719-0933
Mailing address:
  • Phone: 616-719-0919
  • Fax: 616-719-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number5101014627
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number5101014627
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: