Provider Demographics
NPI:1013966324
Name:BECKER, MATHIS LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MATHIS
Middle Name:LEE
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 1:3112 W FIELDER ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-2910
Mailing Address - Country:US
Mailing Address - Phone:813-839-7905
Mailing Address - Fax:
Practice Address - Street 1:12901 BRUCE B. DOWNS BLVD., MDC02
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-396-9934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME12216208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD60345Medicare UPIN
FL00093141Medicare ID - Type UnspecifiedPROVIDER NUMBER