Basic Information
Provider Information | |||||||||
NPI: | 1205804473 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BECKER | ||||||||
FirstName: | PAUL | ||||||||
MiddleName: | LAWRENCE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 260 FORT SANDERS WEST BLVD | ||||||||
Address2: |   | ||||||||
City: | KNOXVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 379223355 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8657694500 | ||||||||
FaxNumber: | 8657694557 | ||||||||
Practice Location | |||||||||
Address1: | 260 FORT SANDERS WEST BLVD | ||||||||
Address2: |   | ||||||||
City: | KNOXVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 379223355 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8655584400 | ||||||||
FaxNumber: | 8657694557 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/14/2006 | ||||||||
LastUpdateDate: | 06/14/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD31304 | TN | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 207XX0005X | 31304 | TN | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
ID | Type | State | Issuer | Description | 200037583 | 01 | TN | RAILROAD MEDICARE | OTHER | 3847085 | 05 | TN |   | MEDICAID | 7904152 | 01 | TN | AETNA | OTHER | 3134233 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 7100119450 | 01 | KY | KY MEDICAID | OTHER | P00851100 | 01 |   | RAILROAD MEDICARE | OTHER | TN0172 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER | TN0196 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER | TN0195 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER |