Provider Demographics
NPI:1609846328
Name:BECKMAN, RANDALL (DPM)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:BECKMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9055 KATY FWY
Mailing Address - Street 2:#460
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1697
Mailing Address - Country:US
Mailing Address - Phone:713-461-1010
Mailing Address - Fax:713-973-7200
Practice Address - Street 1:9055 KATY FWY
Practice Address - Street 2:#460
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1697
Practice Address - Country:US
Practice Address - Phone:713-461-1010
Practice Address - Fax:713-973-7200
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1536213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7271253OtherAETNA
8F2200OtherBCBS
DD3133OtherPALMETTO GBA RAILROAD MEDICARE
TX143488804Medicaid
480033637OtherRAILROAD MEDICARE
TX143488803Medicaid
8F2200OtherBCBS
8F0347Medicare ID - Type Unspecified
7271253OtherAETNA