Provider Demographics
NPI:1700814803
Name:BECK, KIMBERLY E (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:E
Last Name:BECK
Suffix:
Gender:F
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:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:UT
Mailing Address - Zip Code:84634-0640
Mailing Address - Country:US
Mailing Address - Phone:435-528-7935
Mailing Address - Fax:435-528-7936
Practice Address - Street 1:76 EAST CENTER
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:UT
Practice Address - Zip Code:84634
Practice Address - Country:US
Practice Address - Phone:435-528-7935
Practice Address - Fax:435-528-7938
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT94-276640-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1761842OtherFIRST HEALTH INSURANCE
UT870547025 84634 A001OtherTRICARE
UT107007469101OtherINTERMOUNTAIN HEALTH PLAN
UT8997495OtherCIGNA HEALTH PLANS
UT226451OtherDESERT MUTUAL HEALTH BENE
UT870547025BE1OtherEDUCATORS MUTUAL INSURANC
UTQM0000377606OtherALTIUS HEALTH PLANS
UT870547025 84634 A001OtherTRICARE
UTBB3917703Medicare UPIN