Provider Demographics
NPI:1437248077
Name:BECKER, GARRY G (MD)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:G
Last Name:BECKER
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 1:709 W 8TH STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4125
Mailing Address - Country:US
Mailing Address - Phone:307-682-3333
Mailing Address - Fax:307-682-6723
Practice Address - Street 1:709 W 8TH ST
Practice Address - Street 2:FAMILY MEDICAL CARE
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716
Practice Address - Country:US
Practice Address - Phone:307-682-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2376A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYAB7466027OtherDEA
WY301122Medicare ID - Type Unspecified
WYAB7466027OtherDEA