Provider Demographics
NPI:1699898312
Name:BECK, AMY SUSAN (DO)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:SUSAN
Last Name:BECK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N NEW BALLAS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6884
Mailing Address - Country:US
Mailing Address - Phone:314-432-7272
Mailing Address - Fax:
Practice Address - Street 1:555 N NEW BALLAS RD STE 110
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6884
Practice Address - Country:US
Practice Address - Phone:314-432-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE532207R00000X
MO2012003213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01219242OtherRAILROAD MEDICARE
MOP01219242OtherRAILROAD MEDICARE