Provider Demographics
NPI:1336135763
Name:BECKSTEAD, TODD HARRISON (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:HARRISON
Last Name:BECKSTEAD
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 1:419 S WASHINGTON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2951
Mailing Address - Country:US
Mailing Address - Phone:307-577-4220
Mailing Address - Fax:307-235-0931
Practice Address - Street 1:419 S WASHINGTON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2951
Practice Address - Country:US
Practice Address - Phone:307-577-4220
Practice Address - Fax:307-235-0931
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6214A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0069870Medicaid
WY020043010OtherRAILROAD MEDICARE
IA0575142Medicaid
CO01155342Medicaid
WY308059OtherBLUE CROSS BLUE SHIELD
WY114484700Medicaid
WA8359366Medicaid
WYW308059OtherWYOMING MEDICARE
NE520883072Medicaid
MT0069870Medicaid