Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | F3749 | TX |
NPI | 1063490472 |
---|---|
Provider Name | Stephen John Beck |
First Address | Longview, TX 75605-5054 |
Second Address | Tyler, TX 75703-1013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 30/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070001473 | RAILROAD MEDICARE (01) | TX |
8FD396 | BCBS PV# (01) | TX |
C13304 | (02) |