Provider Demographics
NPI:1801909122
Name:BECKSTEAD, DAVID BRADLEY (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRADLEY
Last Name:BECKSTEAD
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 1:41 NORTH 1 EAST
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83263
Mailing Address - Country:US
Mailing Address - Phone:208-852-3851
Mailing Address - Fax:208-852-3856
Practice Address - Street 1:41 NORTH 1 EAST
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:ID
Practice Address - Zip Code:83263
Practice Address - Country:US
Practice Address - Phone:208-852-3851
Practice Address - Fax:208-852-3856
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID804078800Medicaid
842188OtherFIRST HEALTH
ID000010003316OtherREGENCE BLUE SHIELD
UT32287OtherDESERT MUTUAL BENEFIT
ID52118OtherBLUE CROSS
870566919004OtherTRICARE
B63926Medicare UPIN