Provider Demographics
NPI:1720182447
Name:BECKER, ERIC G (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:G
Last Name:BECKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 DAUPHIN ST
Mailing Address - Street 2:STE 7A
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1775
Mailing Address - Country:US
Mailing Address - Phone:251-410-4001
Mailing Address - Fax:251-410-4002
Practice Address - Street 1:3715 DAUPHIN ST STE 7A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1775
Practice Address - Country:US
Practice Address - Phone:251-410-4001
Practice Address - Fax:251-410-4002
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL420207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I081733Medicare PIN
F35065Medicare UPIN
AL51108246OtherBC