Provider Demographics
NPI:1912110933
Name:VIRGIL V BECKER JR JD MD INC PS
Entity Type:Organization
Organization Name:VIRGIL V BECKER JR JD MD INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:V
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:253-833-6241
Mailing Address - Street 1:101 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002
Mailing Address - Country:US
Mailing Address - Phone:253-833-6241
Mailing Address - Fax:253-833-4113
Practice Address - Street 1:125 3RD ST NE STE 401
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4035
Practice Address - Country:US
Practice Address - Phone:253-833-6241
Practice Address - Fax:253-833-4113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027004207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5952460001Medicare NSC
WA8864974Medicare PIN