Provider Demographics
NPI:1477713204
Name:BECKER, GREGORY RYAN (CPO)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:RYAN
Last Name:BECKER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5371
Mailing Address - Street 2:W4657
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-0371
Mailing Address - Country:US
Mailing Address - Phone:206-386-6100
Mailing Address - Fax:206-386-6332
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:W4657
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-386-6100
Practice Address - Fax:206-386-6332
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOI00000294174400000X
WAPS00000315174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist