Provider Demographics
NPI:1841238078
Name:BECKER, JASON M (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
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 1:301 MAIN ST E
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-1803
Mailing Address - Country:US
Mailing Address - Phone:952-758-1050
Mailing Address - Fax:952-758-5011
Practice Address - Street 1:301 MAIN ST E
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-1803
Practice Address - Country:US
Practice Address - Phone:952-758-1050
Practice Address - Fax:952-758-5011
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42811207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN963137200Medicaid
MN963137200Medicaid
MN080011276Medicare ID - Type Unspecified