Healthcare Provider Details

I. General information

NPI: 1841238078
Provider Name (Legal Business Name): JASON M BECKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MAIN ST E SUITE 1
NEW PRAGUE MN
56071-1803
US

IV. Provider business mailing address

301 MAIN ST E SUITE 1
NEW PRAGUE MN
56071-1803
US

V. Phone/Fax

Practice location:
  • Phone: 952-758-1050
  • Fax: 952-758-5011
Mailing address:
  • Phone: 952-758-1050
  • Fax: 952-758-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42811
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number42811
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: