Healthcare Provider Details

I. General information

NPI: 1053502559
Provider Name (Legal Business Name): DENIS I BECKER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 EXECUTIVE DR SUITE 205
RALEIGH NC
27609
US

IV. Provider business mailing address

PO BOX 24848
WINSTON SALEM NC
27114-4848
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-7692
  • Fax: 919-954-3365
Mailing address:
  • Phone: 336-714-2505
  • Fax: 336-714-2550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number17330
License Number StateNC

VIII. Authorized Official

Name: DENIS I BECKER
Title or Position: OWNER DIRECTOR
Credential: MD
Phone: 919-876-7692