Provider Demographics
NPI:1447276548
Name:BECK, PHILLIP H (MD)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:H
Last Name:BECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 FLORIDA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4429
Mailing Address - Country:US
Mailing Address - Phone:209-577-3388
Mailing Address - Fax:209-523-0764
Practice Address - Street 1:1541 FLORIDA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4429
Practice Address - Country:US
Practice Address - Phone:209-577-3388
Practice Address - Fax:209-523-0764
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21753208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACD116ZOtherINDIVIDUAL PTAN- MEDICARE (MODESTO, TURLOCK LOCATIONS)
CACD069BOtherGROUP PTAN - MEDICARE (MANTECA LOCATION)
CACD069AOtherGROUP PTAN- MEDICARE (MODESTO, TURLOCK LOCATIONS)
CACD116YOtherINDIVIDUAL PTAN - MEDICARE (MANTECA LOCATION)
CAZZZ48224ZOtherMEDICARE #
CA00G217530Medicare PIN