Provider Demographics
NPI:1164751038
Name:BECK, RONNIE DALE
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:DALE
Last Name:BECK
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 1:1101 WIMBLEDON DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-7022
Mailing Address - Country:US
Mailing Address - Phone:209-451-8603
Mailing Address - Fax:
Practice Address - Street 1:1101 WIMBLEDON DR
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-7022
Practice Address - Country:US
Practice Address - Phone:209-451-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies