Provider Demographics
NPI:1639284508
Name:BECK, SUSAN L (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:BECK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-222-7474
Mailing Address - Fax:515-222-7491
Practice Address - Street 1:1601 NW 114TH ST STE 151
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7046
Practice Address - Country:US
Practice Address - Phone:515-222-7474
Practice Address - Fax:515-222-7491
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-020912086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2054510Medicaid
IA59021Medicare ID - Type Unspecified
IAE06894Medicare UPIN