Provider Demographics
NPI:1811913635
Name:BECKER, JON P (PA)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:P
Last Name:BECKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NE
Mailing Address - Zip Code:68959-1705
Mailing Address - Country:US
Mailing Address - Phone:308-832-3400
Mailing Address - Fax:
Practice Address - Street 1:727 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NE
Practice Address - Zip Code:68959-1705
Practice Address - Country:US
Practice Address - Phone:308-832-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE583363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE37767OtherBLUE CROSS BLUE SHIELD
NE099212Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
NER81567Medicare UPIN