Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 19537 | MN |
N | 208000000X | Pediatrician | 19537 | MN |
NPI | 1144281965 |
---|---|
Provider Name | Lowell Lester Becker |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Cambridge, MN 55008-1920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 19/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
237382300 | (05) | MN |