Provider Demographics
NPI:1790724599
Name:BECK, DAVID L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:BECK
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 1:4076 CRYSTAL SPRINGS DR NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2041
Mailing Address - Country:US
Mailing Address - Phone:206-780-9745
Mailing Address - Fax:
Practice Address - Street 1:4076 CRYSTAL SPRINGS DR NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2041
Practice Address - Country:US
Practice Address - Phone:206-780-9745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00024405174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5163BEOtherREGENCE RIDER#
WA376418800OtherFEDERAL L&I ID#
WA1641109Medicaid
WA910875163-37OtherKPS ID#
WA0165077OtherL&I ID#
WAA06718Medicare UPIN