Healthcare Provider Details

I. General information

NPI: 1811166325
Provider Name (Legal Business Name): RICKY BECKER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 INTERCHANGE AVE STE 100
BISMARCK ND
58501-2079
US

IV. Provider business mailing address

1500 INTERCHANGE AVE STE 100
BISMARCK ND
58501-2079
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-3011
  • Fax:
Mailing address:
  • Phone: 701-530-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE CARLSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 701-530-3011