Provider Demographics
NPI:1063678795
Name:BECKER, STEPHAN MAX (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:MAX
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 1:2033 N OCOEE ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3918
Mailing Address - Country:US
Mailing Address - Phone:423-458-1020
Mailing Address - Fax:833-638-0070
Practice Address - Street 1:2033 N OCOEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3918
Practice Address - Country:US
Practice Address - Phone:423-458-1020
Practice Address - Fax:833-637-0070
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN482762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry