Healthcare Provider Details

I. General information

NPI: 1962855056
Provider Name (Legal Business Name): THOMAS ANTHONY BECK D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL BLVD
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

7851 S CHADBOURNE DR UNIT A
COTTONWOOD HEIGHTS UT
84121-5806
US

V. Phone/Fax

Practice location:
  • Phone: 435-979-2401
  • Fax:
Mailing address:
  • Phone: 435-979-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code211D00000X
TaxonomyPodiatric Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number6835992-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: