Healthcare Provider Details

I. General information

NPI: 1467567875
Provider Name (Legal Business Name): DANIEL J BECKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 WALNUT GROVE
MEMPHIS TN
38120
US

IV. Provider business mailing address

7600 WOLF RIVER BLVD STE 200
GERMANTOWN TN
38138-1788
US

V. Phone/Fax

Practice location:
  • Phone: 901-383-8860
  • Fax: 901-383-1194
Mailing address:
  • Phone: 901-747-1000
  • Fax: 901-747-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number17991
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number17991
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: