Healthcare Provider Details

I. General information

NPI: 1477713204
Provider Name (Legal Business Name): GREGORY RYAN BECKER CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE W4657
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

PO BOX 5371 W4657
SEATTLE WA
98105-0371
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-6100
  • Fax: 206-386-6332
Mailing address:
  • Phone: 206-386-6100
  • Fax: 206-386-6332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOI00000294
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPS00000315
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: