Provider Demographics
NPI:1124004379
Name:BECKER, JAMES LEE (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LEE
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 1:35303 CABERNET CIR
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-7047
Mailing Address - Country:US
Mailing Address - Phone:515-371-6996
Mailing Address - Fax:
Practice Address - Street 1:35303 CABERNET CIR
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-7047
Practice Address - Country:US
Practice Address - Phone:515-371-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27451207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA050036215OtherRAILROAD MEDICARE #
IA27451OtherTRICARE PROVIDER #
IAIA0146OtherJOHN DEERE PROVIDER #
IA29841OtherBLUE SHIELD PROVIDER #
IA0063685Medicaid
IA29841Medicare ID - Type UnspecifiedMEDICARE PROVIDER #