Provider Demographics
NPI:1033157672
Name:BECKER, ROBERT CONRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CONRAD
Last Name:BECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 980
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-0980
Mailing Address - Country:US
Mailing Address - Phone:662-620-7101
Mailing Address - Fax:662-842-1457
Practice Address - Street 1:620 CROSSOVER ROAD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4944
Practice Address - Country:US
Practice Address - Phone:662-620-7101
Practice Address - Fax:662-842-1457
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS158882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009709460Medicaid
MSP00359769OtherRAILROAD MEDICARE
MS300087629OtherRAILROAD MEDICARE
MS00118711Medicaid
MS300087629OtherRAILROAD MEDICARE
MSG24641Medicare UPIN
MS00118711Medicaid
AL009709460Medicaid