Provider Demographics
NPI:1265540363
Name:BECKFORD, NEAL S (MD)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:S
Last Name:BECKFORD
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 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:7675 WOLF RIVER CIR STE 202
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1747
Practice Address - Country:US
Practice Address - Phone:901-737-3021
Practice Address - Fax:901-737-6063
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16199207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1790948057Medicaid
MS00114085Medicaid
TN3014743Medicaid