Healthcare Provider Details

I. General information

NPI: 1700236882
Provider Name (Legal Business Name): PHILLIP P. BECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 E BROADWAY STE 300
COLUMBIA MO
65201-7167
US

IV. Provider business mailing address

1600 EAST BROADWAY
COLUMBIA MO
65201-5844
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-3550
  • Fax: 573-815-5242
Mailing address:
  • Phone: 573-815-8000
  • Fax: 573-815-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2019017092
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: