Provider Demographics
NPI:1881670768
Name:BECKER, REBECCA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LEE
Last Name:BECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1230 7TH AVE
Mailing Address - Street 2:GERIATRICS
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3166
Mailing Address - Country:US
Mailing Address - Phone:360-636-2400
Mailing Address - Fax:360-636-6285
Practice Address - Street 1:1230 7TH AVE
Practice Address - Street 2:GERIATRICS
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3166
Practice Address - Country:US
Practice Address - Phone:360-636-2400
Practice Address - Fax:360-636-6285
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA33348207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8184822Medicaid
WA8184822Medicaid
WAF87917Medicare UPIN