Provider Demographics
NPI:1679852271
Name:BECKER, JACOB JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:JOSEPH
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 1:1 HOSPITAL DR # DC018.00
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5276
Mailing Address - Country:US
Mailing Address - Phone:573-884-5697
Mailing Address - Fax:573-884-8876
Practice Address - Street 1:1 HOSPITAL DR # DC018.00
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5276
Practice Address - Country:US
Practice Address - Phone:573-884-5697
Practice Address - Fax:573-884-8876
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110198362085R0202X
NMMD2016-01102085R0202X
CODR.00564432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2011019836OtherMISSOURI STATE LICENSE