Provider Demographics
NPI:1255398368
Name:BECKERMAN, ROBERT C (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:BECKERMAN
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 1:13621 PERDIDO KEY DR UNIT W403
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-7488
Mailing Address - Country:US
Mailing Address - Phone:504-669-1376
Mailing Address - Fax:
Practice Address - Street 1:13621 PERDIDO KEY DR UNIT W403
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-7488
Practice Address - Country:US
Practice Address - Phone:504-669-1376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04523R2080P0214X
KS04-322362080P0214X
MO20060344782080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1255398368Medicaid
LA1195081Medicaid
LA5J153Medicare ID - Type Unspecified