Provider Demographics
NPI:1336120971
Name:MUELLER, BECKY JO (DO)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:JO
Last Name:MUELLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12800 ROLLING RIDGE
Mailing Address - Street 2:CENTRACARE CLINIC - BECKER FAMILY MEDICINE
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-8838
Mailing Address - Country:US
Mailing Address - Phone:763-261-7000
Mailing Address - Fax:763-261-7004
Practice Address - Street 1:12800 ROLLING RIDGE
Practice Address - Street 2:CENTRACARE CLINIC - BECKER FAMILY MEDICINE
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308-8838
Practice Address - Country:US
Practice Address - Phone:763-261-7000
Practice Address - Fax:763-261-7004
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46591207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0121081OtherMEDICA HEALTH PLANS
135113OtherU CARE
HP53208OtherHEALTH PARTNERS
1043957OtherPREFERRED ONE
2366395OtherARAZ GROUP AMERICAS PPO
0121082OtherMEDICA HEALTH PLANS
819660500OtherMEDICAL ASSISTANCE
0121080OtherMEDICA HEALTH PLANS
550K4MUOtherBLUE CROSS BLUE SHIELD
2366395OtherARAZ GROUP AMERICAS PPO
H86450Medicare UPIN