Individual
MR. MIKEAL DWAIN BECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CP,LPO
Contact information
Practice address
1709 FORT WORTH HWY, WEATHERFORD, TX 76086-3609
(817) 594-1000
(817) 594-8011
Mailing address
PO BOX 1235, WEATHERFORD, TX 76086-1235
(817) 594-1000
(817) 594-8011
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
77
TX
224P00000X
Prosthetist
77
TX
225000000X
Orthotic Fitter
77
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145839001
—
TX
Enumeration date
07/18/2005
Last updated
04/23/2012
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