Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 106905 | MO |
N | 208000000X | Pediatrician | 106905 | MO |
Y | 2080P0201X | Pediatric Allergist | 106905 | MO |
NPI | 1609887983 |
---|---|
Provider Name | Bradley A Becker |
First Address | Saint Louis, MO 63104-1003 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 15/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207716200 | (05) | MO |
E92323 | (02) | MO |