Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | M-2903 | ID |
NPI | 1265656268 |
---|---|
Provider Name | Dr. David William Becker JR. |
First Address | Twin Falls, ID 83301-4403 |
Second Address | Twin Falls, ID 83301-4403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C36871 | (02) | ID |