Provider Demographics
NPI:1811001001
Name:BECKER, BRIAN K (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
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 18962
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4084
Mailing Address - Country:US
Mailing Address - Phone:800-566-5050
Mailing Address - Fax:254-772-6464
Practice Address - Street 1:601 W HWY 6
Practice Address - Street 2:101
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5575
Practice Address - Country:US
Practice Address - Phone:254-772-5454
Practice Address - Fax:254-772-6464
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1869207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG03631Medicare UPIN
TX8C0857Medicare ID - Type Unspecified