Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036-114125 | IL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 66755 | GA |
NPI | 1104931203 |
---|---|
Provider Name | Paul Richard Beck |
First Address | Stockbridge, GA 30281-9054 |
Second Address | Stockbridge, GA 30281-9054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 06/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01915167 | BLUE CROSS/BLUE SHIELD (01) | IL |
035958001 | DMERC (01) | IL |
036114125 | (05) | IL |
109303 | HEALTH ALLIANCE (01) | IL |
I25279 | (02) | IL |