Provider Demographics
NPI:1184648586
Name:BECKER, W. GARY (MD)
Entity Type:Individual
Prefix:
First Name:W. GARY
Middle Name:
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 1:2302 S UNION AVE STE B18
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1333
Mailing Address - Country:US
Mailing Address - Phone:253-756-0112
Mailing Address - Fax:253-756-0786
Practice Address - Street 1:2302 S UNION AVE STE B18
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1333
Practice Address - Country:US
Practice Address - Phone:253-756-0112
Practice Address - Fax:253-756-0786
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00011964207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1387505Medicaid
WA1387505Medicaid