Provider Demographics
NPI:1548232333
Name:BECKETT, WILLIAM C (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:BECKETT
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 1:3770 7TH TER
Mailing Address - Street 2:#101
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6553
Mailing Address - Country:US
Mailing Address - Phone:772-567-6602
Mailing Address - Fax:772-567-7754
Practice Address - Street 1:3770 7TH TER
Practice Address - Street 2:#101
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6553
Practice Address - Country:US
Practice Address - Phone:772-567-6602
Practice Address - Fax:772-567-7754
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 554802086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09563OtherBLUE CROSS BLUE SHIELD
FL062085800Medicaid
FL770001197OtherRAILROAD MEDICARE #
FL09563BMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL PROV#
FL09563OtherBLUE CROSS BLUE SHIELD