Provider Demographics
NPI:1083815831
Name:BECKLEY, RAYMOND RUSSELL
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:RUSSELL
Last Name:BECKLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 MANZANILLA WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6812
Mailing Address - Country:US
Mailing Address - Phone:760-754-1573
Mailing Address - Fax:
Practice Address - Street 1:240 MANZANILLA WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-6812
Practice Address - Country:US
Practice Address - Phone:760-754-1573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman