Provider Demographics
NPI:1023089802
Name:BECKER, HEBER WEIDLER III (MD)
Entity type:Individual
Prefix:
First Name:HEBER
Middle Name:WEIDLER
Last Name:BECKER
Suffix:III
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:PO BOX 401805
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-1805
Mailing Address - Country:US
Mailing Address - Phone:702-878-0070
Mailing Address - Fax:702-818-1928
Practice Address - Street 1:7220 S CIMARRON RD
Practice Address - Street 2:SUITE 230
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2159
Practice Address - Country:US
Practice Address - Phone:702-878-0070
Practice Address - Fax:702-818-1928
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8900207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXPY203109Q80OtherCALOPTIMA DIRECT
LA1166502Medicaid
NV2018099Medicaid
NM08580278Medicaid
AZ779986Medicaid
CAXPY203109Medicaid
CAXPY203109Q80OtherCALOPTIMA DIRECT
NV31919Medicare PIN