Provider Demographics
NPI:1487697488
Name:BECKERMAN, JAMES G (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:BECKERMAN
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 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:9427 SW BARNES RD
Practice Address - Street 2:SUITE 498
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6652
Practice Address - Country:US
Practice Address - Phone:503-216-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26531207RC0000X
WAMD00049247207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00865966OtherRR MEDICARE
OR028115Medicaid
ORR154626Medicare PIN
ORR156586Medicare PIN
ORR154634Medicare PIN
ORP00326659Medicare PIN
ORP00865966OtherRR MEDICARE
ORH59855Medicare UPIN
ORR158680Medicare PIN
ORR159873Medicare PIN
WAG8897290Medicare PIN
ORR134884Medicare PIN