Basic Information
| Provider Information | |||||||||
| NPI: | 1326017633 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BECKER | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 N MESA | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814013902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702521020 | ||||||||
| FaxNumber: | 9702521041 | ||||||||
| Practice Location | |||||||||
| Address1: | 17 N MESA | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814013902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702521020 | ||||||||
| FaxNumber: | 9702521041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 05/05/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 44040 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 44040 | 01 | CO | STATE STATE OF COLORADO | OTHER | 31957323 | 05 | CO | MEDICAID | AB1087003 | 01 | DEA US DEPT OF JUSTICE | OTHER |