Provider Demographics
NPI:1467593145
Name:BECK, DEWAYNE ALBERT (HSC)
Entity Type:Individual
Prefix:MR
First Name:DEWAYNE
Middle Name:ALBERT
Last Name:BECK
Suffix:
Gender:M
Credentials:HSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 TOMALES RD
Mailing Address - Street 2:USCG TRACEN PETALUMA
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-5002
Mailing Address - Country:US
Mailing Address - Phone:707-765-7525
Mailing Address - Fax:707-765-7495
Practice Address - Street 1:599 TOMALES RD
Practice Address - Street 2:USCG TRACEN PETALUMA
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-5002
Practice Address - Country:US
Practice Address - Phone:707-765-7525
Practice Address - Fax:707-765-7495
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider