=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033351028
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAUL A. BECK MD A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2009
-----------------------------------------------------
Last Update Date | 05/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 W LA VETA AVE STE. 260
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92868-4403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-639-3750
-----------------------------------------------------
Fax | 714-771-5194
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 W LA VETA AVE STE. 260
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92868-4403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-639-3750
-----------------------------------------------------
Fax | 714-771-5194
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PAUL A BECK
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 714-639-3750
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | G56068
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------