Provider Demographics
NPI:1174575898
Name:BECKETT, CHRISTOPHER DONOVAN (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DONOVAN
Last Name:BECKETT
Suffix:
Gender:M
Credentials:DO
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 300
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-0300
Mailing Address - Country:US
Mailing Address - Phone:304-235-1844
Mailing Address - Fax:304-235-2933
Practice Address - Street 1:184 E 2ND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3602
Practice Address - Country:US
Practice Address - Phone:304-235-1844
Practice Address - Fax:304-235-2933
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1875207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64078678Medicaid
WV1810619000Medicaid
WV1810619000Medicaid
KY64078678Medicaid