Provider Demographics
NPI:1669661849
Name:BECK, SHAWN MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MATTHEW
Last Name:BECK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1310 W STEWART DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:714-628-1341
Mailing Address - Fax:714-628-1345
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:SUITE 402
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:714-628-1341
Practice Address - Fax:714-628-1345
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2016-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA96569208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A965690Medicaid
DF504ZMedicare PIN
CA00A965690Medicaid
CADF504ZMedicare Oscar/Certification