Individual
JACOB K TALLEY BECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5501 OLD YORK RD BLDG 4TH, PHILADELPHIA, PA 19141-3018
(215) 456-7900
(215) 456-3428
Mailing address
101 E OLNEY AVE STE 400, PHILADELPHIA, PA 19120-2470
(215) 456-7000
(215) 456-5926
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
C50011662
DE
363A00000X
Physician Assistant
C5-0011662
DE
363A00000X
Physician Assistant
Primary
MA063306
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C5-0011662
DE PROFESSIONAL LICENSE
DE
Enumeration date
01/14/2022
Last updated
01/03/2025
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