Provider Demographics
NPI:1881994515
Name:JAN A BECKER MD PA
Entity type:Organization
Organization Name:JAN A BECKER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-849-0330
Mailing Address - Street 1:727 VASSAR ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4920
Mailing Address - Country:US
Mailing Address - Phone:407-849-0330
Mailing Address - Fax:407-849-0351
Practice Address - Street 1:727 VASSAR ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4920
Practice Address - Country:US
Practice Address - Phone:407-849-0330
Practice Address - Fax:407-849-0351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0035309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47326Medicare PIN