Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 31329 | CO |
NPI | 1134256233 |
---|---|
Provider Name | Dr. Jarrette Allen Beck Jr. |
First Address | Crested Butte, CO 81224-0935 |
Second Address | Alamosa, CO 81101-2340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 23/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D17932 | (02) | CO |