Provider Demographics
NPI:1316948318
Name:BECKER, IRWIN (MD)
Entity type:Individual
Prefix:MR
First Name:IRWIN
Middle Name:
Last Name:BECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5860 RANCH LAKE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-3708
Mailing Address - Country:US
Mailing Address - Phone:941-388-8997
Mailing Address - Fax:941-306-5876
Practice Address - Street 1:5860 RANCH LAKE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3708
Practice Address - Country:US
Practice Address - Phone:941-388-8997
Practice Address - Fax:941-306-5876
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLL556207R00000X
PAMD008241E207Q00000X
FLME121323207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB32735Medicare UPIN