Provider Demographics
NPI:1275956575
Name:BECTON, PAUL WESLEY JR (PA)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:WESLEY
Last Name:BECTON
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4218M ARENDELL ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2866
Mailing Address - Country:US
Mailing Address - Phone:252-808-3100
Mailing Address - Fax:252-808-3120
Practice Address - Street 1:4218M ARENDELL ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2866
Practice Address - Country:US
Practice Address - Phone:252-808-3100
Practice Address - Fax:252-808-3120
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04768363A00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1275956575Medicaid