Provider Demographics
NPI:1790816460
Name:BECKER, STEPHEN NORMAN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:NORMAN
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:PO BOX 9110
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59904-2110
Mailing Address - Country:US
Mailing Address - Phone:406-751-7519
Mailing Address - Fax:406-751-7529
Practice Address - Street 1:350 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2130
Practice Address - Country:US
Practice Address - Phone:406-751-7519
Practice Address - Fax:406-751-7529
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT62002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0044251Medicaid