Basic Information
| Provider Information | |||||||||
| NPI: | 1326035452 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BECKETT | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | ARTHUR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1890 SW HEALTH PARKWAY | ||||||||
| Address2: | STE. 203 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341090473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395143131 | ||||||||
| FaxNumber: | 2395920048 | ||||||||
| Practice Location | |||||||||
| Address1: | 1890 SW HEALTH PARKWAY | ||||||||
| Address2: | STE. 203 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341090473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395143131 | ||||||||
| FaxNumber: | 2395920048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 12/23/2015 | ||||||||
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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 | 207V00000X | ME0058884 | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | ME58884 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 064801900 | 05 | FL | MEDICAID |