Healthcare Provider Details

I. General information

NPI: 1760576151
Provider Name (Legal Business Name): BRYAN B BECK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 7600 PRESBYTERIAN HEART GROUP
ALBUQUERQUE NM
87106-4921
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-2500
  • Fax: 505-563-2599
Mailing address:
  • Phone: 505-923-5356
  • Fax: 505-923-5654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number847
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: