Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | E0804 | TX |
NPI | 1023084639 |
---|---|
Provider Name | Gary L. Becker |
First Address | Waco, TX 76710-2581 |
Second Address | Waco, TX 76710-2581 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 29/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
089821501 | (05) | TX |
C13313 | (02) | TX |