Provider Demographics
NPI:1063611309
Name:JOHN R BECKER JR MD INC
Entity type:Organization
Organization Name:JOHN R BECKER JR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330330-270-8494
Mailing Address - Street 1:550 PARMALEE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1602
Mailing Address - Country:US
Mailing Address - Phone:330-746-4001
Mailing Address - Fax:330-480-6319
Practice Address - Street 1:550 PARMALEE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1602
Practice Address - Country:US
Practice Address - Phone:330-746-4001
Practice Address - Fax:330-480-6319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104489Medicaid
OH0104489Medicaid