Basic Information
Provider Information | |||||||||
NPI: | 1952345142 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BECK | ||||||||
FirstName: | ROBERT | ||||||||
MiddleName: | GARY | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 890 W STETSON AVE | ||||||||
Address2: | SUITE B | ||||||||
City: | HEMET | ||||||||
State: | CA | ||||||||
PostalCode: | 925437311 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9515376002 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 890 W STETSON AVE | ||||||||
Address2: | APEX RADIOLOGY MEDICAL GROUP, INC. | ||||||||
City: | HEMET | ||||||||
State: | CA | ||||||||
PostalCode: | 925437311 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9515376002 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/16/2006 | ||||||||
LastUpdateDate: | 03/11/2013 | ||||||||
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 | 2085R0202X | 20A7614 | CA | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
ID | Type | State | Issuer | Description | 020A76143 | 01 | CA | MEDICARE PTAN | OTHER | 020A76141 | 01 | CA | MEDICARE PTAN | OTHER | 00AX76140 | 05 | CA |   | MEDICAID | 020A76144 | 01 | CA | MEDICARE PTAN | OTHER | 020A76145 | 01 | CA | MEDICARE PTAN | OTHER |