Provider Demographics
NPI:1255519260
Name:BRADLEY K BECKER, PC
Entity type:Organization
Organization Name:BRADLEY K BECKER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-867-1302
Mailing Address - Street 1:18555 N 79TH AVE STE B102
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8372
Mailing Address - Country:US
Mailing Address - Phone:602-439-1111
Mailing Address - Fax:602-867-4247
Practice Address - Street 1:18555 N 79TH AVE STE B102
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8372
Practice Address - Country:US
Practice Address - Phone:602-610-9111
Practice Address - Fax:602-867-4247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38032086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ104458Medicare PIN