Provider Demographics
NPI:1407387475
Name:BECKERMAN, SAMUEL ROBERT (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ROBERT
Last Name:BECKERMAN
Suffix:
Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:1200 N STATE ST
Mailing Address - Street 2:CLINIC TOWER SUITE A7D
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1029
Mailing Address - Country:US
Mailing Address - Phone:415-215-3229
Mailing Address - Fax:323-226-8101
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:CLINIC TOWER SUITE A7D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1029
Practice Address - Country:US
Practice Address - Phone:323-226-6937
Practice Address - Fax:323-226-8101
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA157860207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine