Provider Demographics
NPI:1376619171
Name:BECK, PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:BECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4515 MARTIN LUTHER KING JR WAY S
Mailing Address - Street 2:#100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-2182
Mailing Address - Country:US
Mailing Address - Phone:206-320-5325
Mailing Address - Fax:206-320-5326
Practice Address - Street 1:1620 43RD AVE E
Practice Address - Street 2:#4B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3266
Practice Address - Country:US
Practice Address - Phone:206-618-7729
Practice Address - Fax:206-325-0366
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00024219207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601 314 648OtherUBI NUMBER
WA1030715OtherDSHS PROVIDER NUMBER
WAAB03806Medicare ID - Type Unspecified
WA1030715OtherDSHS PROVIDER NUMBER