Provider Demographics
NPI:1962583013
Name:BECK, MARVIN LOWERY (MD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:LOWERY
Last Name:BECK
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 1:3203 METHODIST DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7434
Mailing Address - Country:US
Mailing Address - Phone:870-935-1800
Mailing Address - Fax:870-935-2917
Practice Address - Street 1:3203 METHODIST DRIVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72403-9069
Practice Address - Country:US
Practice Address - Phone:870-935-1800
Practice Address - Fax:870-935-2917
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7456208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119050001Medicaid
AR54585Medicare ID - Type Unspecified
ARE91669Medicare UPIN