MEDICARE: BRYAN L BECK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	1015	ME
2	207P00000X	Emergency Medicine Physician	1015	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184654568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN L BECK D.O.

Provider Business Mailing Address
First Line	:	301 US ROUTE 1
Second Line	:	BUILDING C
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-7609
Country	:	US
Telephone Number	:	207-396-8600
Fax Number	:	207-396-8632

Provider Business Practice Location Address
First Line	:	47 PLEASANT VW
Second Line	:
City	:	HARRISON
State	:	ME
Zip	:	04040-4039
Country	:	US
Telephone Number	:	207-583-6103
Fax Number	:	207-583-6096

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	01/03/2011

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