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General NPI Number Information
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NPI Number | 1649269457
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Entity Type | Individual
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Provider Name | ROGER GARY BECK DPM
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Gender | Male
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 09/01/2007
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Provider Practice Location Address
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Address Line | 619 S MARION AVE SURGICAL SERVICES
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City | LAKE CITY
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State | FL
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Zip | 32025-5808
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Country | US
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Telephone | 386-755-3916
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Fax |
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Provider Business Mailing Address
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Address Line | 20274 NW 251ST TER
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City | HIGH SPRINGS
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State | FL
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Zip | 32643-2357
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Country | US
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Telephone | 386-755-3016
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Fax |
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO 2071
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License Number State | FL
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