Healthcare Provider Details

I. General information

NPI: 1093709552
Provider Name (Legal Business Name): LANCE J BECKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 FAWCETT AVE STE 100
TACOMA WA
98402-1900
US

IV. Provider business mailing address

PO BOX 3247
EVANSVILLE IN
47731-3247
US

V. Phone/Fax

Practice location:
  • Phone: 253-761-4200
  • Fax:
Mailing address:
  • Phone: 800-467-2392
  • Fax: 812-471-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD61561453
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD073439L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: