Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 125-060504 | IL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | PENDING | KY |
NPI | 1184912909 |
---|---|
Provider Name | Dr. Ryan Tyler Beck |
First Address | Herrin, IL 62948-6334 |
Second Address | Paducah, KY 42001-6789 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2011 |
Last Update Date | 16/06/2017 |