Provider Demographics
NPI:1942854419
Name:BECK, LUKE DAVID (RD, LD)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:DAVID
Last Name:BECK
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 N 2800 E
Mailing Address - Street 2:
Mailing Address - City:ROBERTS
Mailing Address - State:ID
Mailing Address - Zip Code:83444
Mailing Address - Country:US
Mailing Address - Phone:208-766-3843
Mailing Address - Fax:
Practice Address - Street 1:2325 CORONADO ST.
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-542-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1136133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered