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General NPI Number Information
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NPI Number | 1003019555
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Entity Type | Organization
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Legal Business Name | PERRY K. BECKSTROM, DO
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 09/17/2008
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Provider Practice Location Address
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Address Line | 3946 S BUCKNER BLVD STE 200
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City | DALLAS
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State | TX
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Zip | 75227-4313
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Country | US
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Telephone | 214-381-7194
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Fax | 214-381-7195
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Provider Business Mailing Address
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Address Line | 3946 S BUCKNER BLVD STE 200
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City | DALLAS
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State | TX
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Zip | 75227-4313
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Country | US
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Telephone | 214-381-7194
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Fax | 214-381-7195
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. PERRYK KENT BECKSTROM
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Credential | DO
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Telephone | 214-381-7194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L9622
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License Number State | TX
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