Provider Demographics
NPI:1528101623
Name:BECKER, ALBERT E (MD LLC)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:E
Last Name:BECKER
Suffix:
Gender:M
Credentials:MD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 687
Mailing Address - Street 2:SUITE O
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45501-0687
Mailing Address - Country:US
Mailing Address - Phone:937-206-7922
Mailing Address - Fax:
Practice Address - Street 1:362 S BURNETT RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-2604
Practice Address - Country:US
Practice Address - Phone:937-206-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34785207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0399859Medicaid
OH0463973Medicare PIN