Provider Demographics
NPI:1467661488
Name:BECKER, BRIAN KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KEITH
Last Name:BECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3938 E GRANT RD
Mailing Address - Street 2:P.M.B. #444
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2559
Mailing Address - Country:US
Mailing Address - Phone:520-647-7992
Mailing Address - Fax:520-647-7950
Practice Address - Street 1:3938 E GRANT RD
Practice Address - Street 2:P.M.B. #444
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2559
Practice Address - Country:US
Practice Address - Phone:520-647-7992
Practice Address - Fax:520-647-7950
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25749208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice