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General NPI Number Information
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NPI Number | 1053459875
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Entity Type | Individual
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Provider Name | MICHAEL SCOTT BECKER MPAS PAC
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Gender | Male
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 12/30/2010
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Provider Practice Location Address
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Address Line | 2725 KEITH STREET NW
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City | CLEVELAND
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State | TN
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Zip | 37312
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Country | US
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Telephone | 423-476-3330
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Fax | 472-476-5802
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Provider Business Mailing Address
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Address Line | 2725 KEITH STREET NW
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City | CLEVELAND
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State | TN
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Zip | 37312
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Country | US
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Telephone | 423-476-3330
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Fax | 472-476-5802
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA0000000148
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License Number State | TN
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