Provider Demographics
NPI:1457649808
Name:BECKER, MARY SHANNON CLOW (MD)
Entity Type:Individual
Prefix:
First Name:MARY SHANNON
Middle Name:CLOW
Last Name:BECKER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4128
Mailing Address - Fax:970-490-4340
Practice Address - Street 1:595 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-1920
Practice Address - Country:US
Practice Address - Phone:970-826-0911
Practice Address - Fax:970-826-0910
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2021-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COCO50848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine