Provider Demographics
NPI:1932390077
Name:RUSSELL A. BECK, MD, PC
Entity Type:Organization
Organization Name:RUSSELL A. BECK, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-644-1001
Mailing Address - Street 1:4824 E BASELINE RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4676
Mailing Address - Country:US
Mailing Address - Phone:480-644-1001
Mailing Address - Fax:480-464-8722
Practice Address - Street 1:4824 E BASELINE RD
Practice Address - Street 2:SUITE 129
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4676
Practice Address - Country:US
Practice Address - Phone:480-644-1001
Practice Address - Fax:480-464-8722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17248207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ288036Medicaid
AZ288036Medicaid