Provider Demographics
NPI:1184654568
Name:BECK, BRYAN L (DO)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:L
Last Name:BECK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 US ROUTE 1
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7609
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:47 PLEASANT VW
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:ME
Practice Address - Zip Code:04040-4039
Practice Address - Country:US
Practice Address - Phone:207-583-6103
Practice Address - Fax:207-583-6096
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1015204D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME329760099Medicaid
NH30223010Medicaid
ME01530901Medicare PIN
MENX1111Medicare PIN
ME015309Medicare PIN
MED93079Medicare UPIN
NH30223010Medicaid