Healthcare Provider Details

I. General information

NPI: 1518910546
Provider Name (Legal Business Name): JOSE R BECEIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 4TH ST
LUBBOCK TX
79430-3859
US

IV. Provider business mailing address

3702 76TH ST
LUBBOCK TX
79423-1212
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-3150
  • Fax: 806-743-2893
Mailing address:
  • Phone: 806-792-3251
  • Fax: 806-743-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberE1985
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: