MEDICARE: SAMUEL BECK MD

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	208000000X	Pediatrics Physician	0101258699	VA
2	208000000X	Pediatrics Physician	MD61270008	WA

General Provider Information

NPI Number	:	1720402993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL BECK MD

Provider Business Mailing Address
First Line	:	PO BOX 421
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-0421
Country	:	US
Telephone Number	:	866-747-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	23813 E APPLEWAY AVE
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-9684
Country	:	US
Telephone Number	:	509-928-6383
Fax Number	:	509-227-7070

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

Provider Enumeration Date	:	02/09/2014
Last Update Date	:	08/22/2023

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Directions to “ SAMUEL BECK MD” Practice Location

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