Provider Demographics
NPI:1831572619
Name:BECKSVOORT, CODY (DO)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:BECKSVOORT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4882
Mailing Address - Country:US
Mailing Address - Phone:803-773-5227
Mailing Address - Fax:803-757-4010
Practice Address - Street 1:674 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4882
Practice Address - Country:US
Practice Address - Phone:803-773-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101021542OtherMEDICAL LICENSE NUMBER