Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD00027574 | WA |
N | 2080P0201X | Pediatric Allergist | MD00027574 | WA |
NPI | 1952347916 |
---|---|
Provider Name | Dr. Jonathan W Becker |
First Address | Fort Riley, KS 66442-4030 |
Second Address | Fort Riley, KS 66442-4030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 28/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G01963 | (02) | WA |