Provider Demographics
NPI:1952508822
Name:BECKUM, KATHLEEN MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARTIN
Last Name:BECKUM
Suffix:
Gender:F
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 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:2000 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2110
Practice Address - Country:US
Practice Address - Phone:205-801-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007018072207N00000X
AL29214207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL129265Medicaid
AL051118022OtherBCBS
AL051118020OtherBCBS
AL051118023OtherBCBS
AL129278Medicaid
AL129282Medicaid
AL051118019OtherBCBS
AL051118021OtherBCBS
AL129275Medicaid
MS09634291Medicaid
AL129283Medicaid
AL051118023OtherBCBS