Provider Demographics
NPI:1124162789
Name:BECKER, EDWARD HENRY GEORGE III (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:HENRY GEORGE
Last Name:BECKER
Suffix:III
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13837 CIRCA CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4382
Mailing Address - Country:US
Mailing Address - Phone:813-684-2663
Mailing Address - Fax:813-685-9178
Practice Address - Street 1:13837 CIRCA CROSSING DR
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-4382
Practice Address - Country:US
Practice Address - Phone:813-684-2663
Practice Address - Fax:813-685-6222
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116897207X00000X
FLME 116897207XX0005X, 207XX0005X
DEC10010063207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009249300Medicaid
DE1124162789Medicaid
3884073000OtherAMERIHEALTH
240848Medicare UPIN