Provider Demographics
NPI:1306825633
Name:BECK, KATHRYN A (MD)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:A
Last Name:BECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:YOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:801E PLANO PKWY 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6894
Mailing Address - Country:US
Mailing Address - Phone:972-422-5941
Mailing Address - Fax:972-881-4390
Practice Address - Street 1:5300 TALLMAN AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3932
Practice Address - Country:US
Practice Address - Phone:206-291-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60077512207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82302561Medicaid
COI 10278Medicare UPIN
CO540978Medicare ID - Type Unspecified