Provider Demographics
NPI:1588637698
Name:BECKER, ROYAL M (MD)
Entity Type:Individual
Prefix:
First Name:ROYAL
Middle Name:M
Last Name:BECKER
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 1:501 S RAGSDALE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-2434
Mailing Address - Country:US
Mailing Address - Phone:903-541-5000
Mailing Address - Fax:
Practice Address - Street 1:501 S RAGSDALE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-2434
Practice Address - Country:US
Practice Address - Phone:903-541-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2416207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042769201Medicaid
TX042769202Medicaid
TXTAX ID AND 042 LOCATOtherTRICARE
TX122996OtherSUPERIOR/CHIPS
TX5313551OtherAETNA
TX83Y744OtherBCBS OF TEXAS
TXTAX ID AND 042 LOCATOtherTRICARE
TXG26553Medicare UPIN