Provider Demographics
NPI:1831254127
Name:BECKER, DEVRA BEYER (MD)
Entity type:Individual
Prefix:DR
First Name:DEVRA
Middle Name:BEYER
Last Name:BECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEVRA
Other - Middle Name:
Other - Last Name:BEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1068 CRESTHAVEN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0809
Mailing Address - Country:US
Mailing Address - Phone:901-866-8864
Mailing Address - Fax:
Practice Address - Street 1:1068 CRESTHAVEN RD STE 500
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0846
Practice Address - Country:US
Practice Address - Phone:901-866-8525
Practice Address - Fax:901-302-2525
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001001460208200000X, 2082S0099X, 2082S0105X
OH35.090140208200000X
TN65086208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2839094Medicaid
TNQ074445Medicaid
OHP00678088OtherMEDICARE RAILROAD