Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | M-12928 | ID |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | M-12928 | ID |
N | 208200000X | Surgeon | M-12928 | ID |
N | 208600000X | Surgeon | M-12928 | ID |
NPI | 1164657854 |
---|---|
Provider Name | Dr. James Thomas Beckmann |
First Address | Boise, ID 83702-1868 |
Second Address | Boise, ID 83702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2009 |
Last Update Date | 01/08/2018 |