Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 12007134 | IN |
NPI | 1093832875 |
---|---|
Provider Name | Russell P Beckett |
First Address | New Castle, IN 47362-4355 |
Second Address | New Castle, IN 47362-4355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2007 |
Last Update Date | 08/07/2007 |