Individual
BRADLEY A BECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 268-4014
(314) 268-2712
Mailing address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 268-4104
(314) 268-2712
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
106905
MO
208000000X
Pediatrics Physician
106905
MO
2080I0007X
Pediatric Clinical & Laboratory Immunology Physician
106905
MO
2080P0201X
Pediatric Allergy/Immunology Physician
Primary
106905
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207716200
—
MO
Enumeration date
08/11/2006
Last updated
01/15/2021
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