Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | C10010063 | DE |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A115181 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME 116897 | FL |
NPI | 1124162789 |
---|---|
Provider Name | Dr. Edward H. Becker III |
First Address | Brandon, FL 33511-5972 |
Second Address | Brandon, FL 33511-5972 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 17/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1124162789 | (05) | DE |
240848 | (02) | |
3884073000 | AMERIHEALTH (01) | |
9185848 | AETNA (01) |