Provider Demographics
NPI:1760587398
Name:BECTON, PAUL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:BECTON
Suffix:JR
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 1:1000 W KINGSHIGHWAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450
Mailing Address - Country:US
Mailing Address - Phone:870-236-9988
Mailing Address - Fax:870-236-9994
Practice Address - Street 1:1000 W KINGSHIGHWAY
Practice Address - Street 2:SUITE 6
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4141
Practice Address - Country:US
Practice Address - Phone:870-236-9988
Practice Address - Fax:870-236-9994
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5756174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101350001Medicaid
AR710797390OtherTIN
AR101350001Medicaid
AR50374Medicare ID - Type Unspecified