Provider Demographics
NPI:1235327867
Name:PAUL BECTON, JR, MD, PA
Entity Type:Organization
Organization Name:PAUL BECTON, JR, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-236-9988
Mailing Address - Street 1:1000 W KINGSHIGHWAY STE 6
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4197
Mailing Address - Country:US
Mailing Address - Phone:870-236-9988
Mailing Address - Fax:870-236-9994
Practice Address - Street 1:1000 W KINGSHIGHWAY STE 6
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4197
Practice Address - Country:US
Practice Address - Phone:870-236-9988
Practice Address - Fax:870-236-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5756207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101350001Medicaid
AR101350001Medicaid