Provider Demographics
NPI:1366425019
Name:BECKETT, WILLIAM W JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:W
Last Name:BECKETT
Suffix:JR
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 1:2015 ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3003
Mailing Address - Country:US
Mailing Address - Phone:334-793-9511
Mailing Address - Fax:334-794-6412
Practice Address - Street 1:1900 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3008
Practice Address - Country:US
Practice Address - Phone:334-793-9511
Practice Address - Fax:334-794-6412
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL162922085N0700X, 2085R0202X
MI43015049192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009996505Medicaid
AL000084260Medicaid
AL009996525Medicaid
AL009996515Medicaid
AL009996515Medicaid
ALF08438Medicare UPIN