Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2901017880 | MI |
NPI | 1104956226 |
---|---|
Provider Name | Dr. Christopher Barrett Beck |
First Address | Port Huron, MI 48060-3105 |
Second Address | Port Huron, MI 48060-3105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0G41022 | BCBS MEDICAL (01) | MI |
V02122 | (02) | MI |