Provider Demographics
NPI:1578672671
Name:BECK, RUSSELL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:ALAN
Last Name:BECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 748860
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8860
Mailing Address - Country:US
Mailing Address - Phone:480-644-1001
Mailing Address - Fax:480-464-8722
Practice Address - Street 1:4824 E BASELINE RD STE 129
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4679
Practice Address - Country:US
Practice Address - Phone:480-644-1001
Practice Address - Fax:480-464-8722
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ17248207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ288036Medicaid
AZD43691Medicare UPIN