Individual
SAMUEL WELLING BECKSTEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2100 PROVIDENCE WAY, IDAHO FALLS, ID 83404-4951
(208) 529-6600
(208) 529-6602
Mailing address
2100 PROVIDENCE WAY, IDAHO FALLS, ID 83404-4951
(082) 529-6600
(208) 529-6602
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
O-1389
ID
207W00000X
Ophthalmology Physician
OS020090
PA
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
O-1389
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/20/2015
Last updated
11/05/2020
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