Provider Demographics
NPI:1023036985
Name:BECKMANN, SARAH MOONEY (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MOONEY
Last Name:BECKMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:COLE
Other - Last Name:MOONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:924 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5441
Mailing Address - Country:US
Mailing Address - Phone:507-333-3300
Mailing Address - Fax:507-333-3214
Practice Address - Street 1:924 1ST ST NE
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5441
Practice Address - Country:US
Practice Address - Phone:507-333-3300
Practice Address - Fax:507-333-3214
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30737208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN360887500Medicaid
MN360887500Medicaid
D48392Medicare UPIN
MN379000468Medicare ID - Type Unspecified