Healthcare Provider Details

I. General information

NPI: 1144849381
Provider Name (Legal Business Name): ALEX BECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 LEAVENWORTH ST
OMAHA NE
68102-3215
US

IV. Provider business mailing address

1515 E BETHANY HOME RD STE 120
PHOENIX AZ
85014-2496
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-3222
  • Fax: 402-552-2172
Mailing address:
  • Phone: 602-812-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number69112
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: