Provider Demographics
NPI:1063605921
Name:BECK, JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
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:PO BOX 26395
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2014
Mailing Address - Country:US
Mailing Address - Phone:812-376-0700
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:2400 NORTHPARK DR STE 20
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-4467
Practice Address - Country:US
Practice Address - Phone:812-376-0700
Practice Address - Fax:812-376-8625
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01071468A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3854117OtherCIGNA PROVIDER ID
IN201077930Medicaid
IN000001078376OtherANTHEM PROVIDER ID
INCS1804000252OtherCARESOURCE PROVIDER ID