Healthcare Provider Details

I. General information

NPI: 1528101623
Provider Name (Legal Business Name): ALBERT E BECKER M.D. LLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 S BURNETT RD
SPRINGFIELD OH
45505-2604
US

IV. Provider business mailing address

PO BOX 687 SUITE O
SPRINGFIELD OH
45501-0687
US

V. Phone/Fax

Practice location:
  • Phone: 937-206-7922
  • Fax:
Mailing address:
  • Phone: 937-206-7922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34785
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: