Provider Demographics
NPI:1932499381
Name:BECK, FREDERICK COLEMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:COLEMAN
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 1:611 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-2847
Mailing Address - Country:US
Mailing Address - Phone:904-394-8069
Mailing Address - Fax:904-394-8069
Practice Address - Street 1:611 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-2847
Practice Address - Country:US
Practice Address - Phone:904-394-8069
Practice Address - Fax:904-394-8069
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME000047236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine