Provider Demographics
NPI:1275573867
Name:BECKER, KENNETH ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALAN
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 1:90000 HOEY
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-8581
Mailing Address - Country:US
Mailing Address - Phone:401-741-7272
Mailing Address - Fax:
Practice Address - Street 1:1801 N BELCHER RD STE B
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1452
Practice Address - Country:US
Practice Address - Phone:727-935-0503
Practice Address - Fax:727-935-0504
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10937207N00000X
NC2006-01915207N00000X
FLME164038207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI03-00628OtherUNITED HEALTHCARE
RI0000026434OtherBLUE CROSS BLUE SHIELD RI
RI409753OtherBCBSRI-BLUECHIP
RI109370OtherTUFTS
RI007009639Medicare ID - Type Unspecified
RIH60821Medicare UPIN