Healthcare Provider Details

I. General information

NPI: 1538187000
Provider Name (Legal Business Name): ANNE M BECK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
ST. LOUIS MO
63104-1003
US

IV. Provider business mailing address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-4010
  • Fax: 314-268-6449
Mailing address:
  • Phone: 314-577-5662
  • Fax: 314-268-6449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberR8N99
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1536407
Identifier TypeMEDICAID
Identifier StateLA
Identifier Issuer
# 2
Identifier1517410
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer
# 3
Identifier121158
Identifier TypeMEDICAID
Identifier StateMS
Identifier Issuer
# 4
Identifier144010381
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: