Provider Demographics
NPI:1194700609
Name:BECKER, STEPHEN GERARD (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GERARD
Last Name:BECKER
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 1:1750 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031
Mailing Address - Country:US
Mailing Address - Phone:541-386-5070
Mailing Address - Fax:541-386-7190
Practice Address - Street 1:1750 12TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031
Practice Address - Country:US
Practice Address - Phone:541-386-5070
Practice Address - Fax:541-386-7190
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11746207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080028717OtherRAILROAD MEDICARE
WA64123OtherDEPT OF LABOR AND INDUSTR
OR00823Medicaid
WA8114647Medicaid
OH11003OtherBLUE CROSS BLUE SHIELD
1251233OtherUNITED HEALTHCARE
K5099 01OtherPACIFIC SOURCE
000WCJPVAMedicare ID - Type Unspecified
OR00823Medicaid