Provider Demographics
NPI:1750440491
Name:BECKHAM, GERALD EDWARD (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:EDWARD
Last Name:BECKHAM
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 1:12462 PUTNAM ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1048
Mailing Address - Country:US
Mailing Address - Phone:562-789-5430
Mailing Address - Fax:
Practice Address - Street 1:12462 PUTNAM ST
Practice Address - Street 2:SUITE 203
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1048
Practice Address - Country:US
Practice Address - Phone:562-789-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95410207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology