Provider Demographics
NPI:1114120474
Name:BECK, JASON D (M D)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:BECK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 HIGHWAY 614
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39562
Mailing Address - Country:US
Mailing Address - Phone:228-588-6622
Mailing Address - Fax:228-588-9399
Practice Address - Street 1:2740 S ELM AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-5435
Practice Address - Country:US
Practice Address - Phone:559-457-5200
Practice Address - Fax:559-457-5296
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21210207Q00000X
390200000X
CAC135430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program