Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 1875 | WV |
NPI | 1174575898 |
---|---|
Provider Name | Christopher Donovan Beckett |
First Address | Williamson, WV 25661-0300 |
Second Address | Williamson, WV 25661-3602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 26/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1810619000 | (05) | WV |
64078678 | (05) | KY |
H92147 | (02) | WV |