Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 32887 | NE |
NPI | 1659790954 |
---|---|
Provider Name | Bradford Becken III |
First Address | Omaha, NE 68114-4113 |
Second Address | Durham, NC 27710-4699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 18/09/2020 |