Healthcare Provider Details

I. General information

NPI: 1245247071
Provider Name (Legal Business Name): MICHAEL D. BECKER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 S EASTERN AVE
LAS VEGAS NV
89119-5102
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 702-724-8787
  • Fax:
Mailing address:
  • Phone: 702-877-0814
  • Fax: 702-877-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberDO1538
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number5101015443
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: