Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 01067907A | IN |
N | 208800000X | Urologist | 43349 | KY |
NPI | 1053575365 |
---|---|
Provider Name | Aaron Blake Becker |
First Address | Jeffersonville, IN 47130-3769 |
Second Address | Jeffersonville, IN 47130-3769 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2008 |
Last Update Date | 18/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201028410 | (05) | IN |
7100127030 | (05) | KY |
P00895272 | RAILROAD MEDICARE (01) | KY |
P00895273 | RAILROAD MEDICARE (01) | IN |