Healthcare Provider Details

I. General information

NPI: 1083686158
Provider Name (Legal Business Name): JOHN R. BECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11123 S TOWNE SQ STE. E
SAINT LOUIS MO
63123-7816
US

IV. Provider business mailing address

834 STATE ST
CHESTER IL
62233-1640
US

V. Phone/Fax

Practice location:
  • Phone: 314-487-4537
  • Fax:
Mailing address:
  • Phone: 314-771-3153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number36087806
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number105823
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: