Individual
CHARLIE BECKNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
21532
KY
207NS0135X
Procedural Dermatology Physician
21532
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000044793
ANTHEM
—
01
—
0300056
UNITED HEALTHCARE
KY
05
—
64215320
—
KY
01
—
C03007
CUMBERLAND HEALTHCARE
—
Enumeration date
05/31/2005
Last updated
12/16/2013
Update your record
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