Provider Demographics
NPI:1477521193
Name:BECKETT, TIMOTHY D (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:BECKETT
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 1:10120 S EASTERN AVE
Mailing Address - Street 2:#200
Mailing Address - City:HENDERSON NV
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-222-3238
Mailing Address - Fax:702-221-2231
Practice Address - Street 1:10120 S EASTERN AVE
Practice Address - Street 2:#200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-222-3238
Practice Address - Fax:702-221-2231
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10395207L00000X
CAC138537207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500198Medicaid
NV39278Medicare ID - Type Unspecified
H80989Medicare UPIN