Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 77 | TX |
Y | 222Z00000X | Podiatrist | 77 | TX |
N | 224P00000X | Prosthetist | 77 | TX |
N | 225000000X | Orthotic Fitter | 77 | TX |
NPI | 1174522668 |
---|---|
Provider Name | Mr. Mikeal Dwain Beck |
First Address | Weatherford, TX 76086-1235 |
Second Address | Weatherford, TX 76086-3609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 23/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
145839001 | (05) | TX |