Provider Demographics
NPI:1780674374
Name:BECKER, TERRY S (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:S
Last Name:BECKER
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:223 N 1ST AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7089
Mailing Address - Country:US
Mailing Address - Phone:626-821-1411
Mailing Address - Fax:626-821-0406
Practice Address - Street 1:65 N MADISON AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2035
Practice Address - Country:US
Practice Address - Phone:626-793-8189
Practice Address - Fax:626-795-3975
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG246842085B0100X, 2085N0904X, 2085R0202X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G246840Medicaid
CAWG24684Medicare ID - Type Unspecified
CAWG24684RMedicare UPIN
CA00G246840Medicaid