Provider Demographics
NPI:1992736359
Name:BECKER, KEITH ALAN (IDC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ALAN
Last Name:BECKER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BRANCH MEDICAL CLINIC
Mailing Address - Street 2:NAVAL WEAPONS STATION
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23691-0091
Mailing Address - Country:US
Mailing Address - Phone:757-314-6148
Mailing Address - Fax:
Practice Address - Street 1:BRANCH MEDICAL CLINIC
Practice Address - Street 2:NAVAL WEAPONS STATION
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23691-0091
Practice Address - Country:US
Practice Address - Phone:757-314-6148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman