Provider Demographics
NPI:1184996134
Name:BECKER, WILLIAM JOHN (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOHN
Last Name:BECKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 7888260
Mailing Address - Street 2:
Mailing Address - City:TWNETYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92278
Mailing Address - Country:US
Mailing Address - Phone:760-830-6613
Mailing Address - Fax:
Practice Address - Street 1:MCAGCC
Practice Address - Street 2:BUILDING 1538
Practice Address - City:TWNETYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92278
Practice Address - Country:US
Practice Address - Phone:760-830-6613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA57992363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant