Provider Demographics
NPI:1265460661
Name:BECKWORTH, DENNIS D (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:D
Last Name:BECKWORTH
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 1:8514 CORMORANT COVE CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4393
Mailing Address - Country:US
Mailing Address - Phone:907-562-0321
Mailing Address - Fax:907-562-2683
Practice Address - Street 1:133 ROUTE 3
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-645-5546
Practice Address - Fax:671-645-5549
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4225207RX0202X
GUMTL-2018-007207RX0202X
IDM-14552207RX0202X
GUM-2121207RX0202X
ORMD11142207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1009058Medicaid
AKMD07772Medicaid
AKLISCENCEOtherAA4225
AKK152932Medicare ID - Type Unspecified