Basic Information
| Provider Information | |||||||||
| NPI: | 1114120474 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BECK | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | M. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7001 HIGHWAY 614 | ||||||||
| Address2: | |||||||||
| City: | MOSS POINT | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285886622 | ||||||||
| FaxNumber: | 2285889399 | ||||||||
| Practice Location | |||||||||
| Address1: | 2740 S ELM AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937065435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594575200 | ||||||||
| FaxNumber: | 5594575296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 06/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21210 | MS | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | C135430 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.