Provider Demographics
NPI:1609269182
Name:THOMAS A. BECKETT M.D., LLC
Entity Type:Organization
Organization Name:THOMAS A. BECKETT M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BECKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-514-3131
Mailing Address - Street 1:1865 VETERANS PARK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0447
Mailing Address - Country:US
Mailing Address - Phone:239-514-3131
Mailing Address - Fax:239-572-6101
Practice Address - Street 1:1865 VETERANS PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0447
Practice Address - Country:US
Practice Address - Phone:239-514-3131
Practice Address - Fax:239-572-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064801900Medicaid