Provider Demographics
NPI:1992701734
Name:BECKMAN, SCOTT ANDREW (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ANDREW
Last Name:BECKMAN
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 1:613 DORBETT ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2615
Mailing Address - Country:US
Mailing Address - Phone:812-481-2229
Mailing Address - Fax:812-482-3993
Practice Address - Street 1:613 DORBETT ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2615
Practice Address - Country:US
Practice Address - Phone:812-481-2229
Practice Address - Fax:812-482-3993
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048888207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200322270Medicaid
IN180290Medicare ID - Type Unspecified
INH37121Medicare UPIN
IN200322270Medicaid