Individual
JACOB K TALLEY BECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
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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