Provider Demographics
NPI:1184682494
Name:BECKER, VINCENT GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:GERARD
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 1:1301 SUNSET DR
Mailing Address - Street 2:STE 3
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-7906
Mailing Address - Country:US
Mailing Address - Phone:423-926-4966
Mailing Address - Fax:423-926-1823
Practice Address - Street 1:1301 SUNSET DR
Practice Address - Street 2:STE 3
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-7906
Practice Address - Country:US
Practice Address - Phone:423-926-4966
Practice Address - Fax:423-926-1823
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN349692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64031164OtherKENTUCKY MEDICAID
VA7239875OtherVIRGINIA MEDICAID
TN3862458Medicaid
TN4007341OtherBCBS
NC89064NJOtherNORTH CAROLINA MEDICAID
TNH33210Medicare UPIN
TN3862458Medicare ID - Type Unspecified