Provider Demographics
NPI:1578500542
Name:BECKROW, JASON RICHARD (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RICHARD
Last Name:BECKROW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4025 HEALTH PARK LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3421
Mailing Address - Country:US
Mailing Address - Phone:269-429-7100
Mailing Address - Fax:269-429-1959
Practice Address - Street 1:4025 HEALTH PARK LN
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3421
Practice Address - Country:US
Practice Address - Phone:269-429-7100
Practice Address - Fax:269-429-1959
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014627207RH0003X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5461172Medicaid
MI5461172Medicaid