Provider Demographics
NPI:1730520164
Name:BECKER, WILLEM M (DVM)
Entity type:Individual
Prefix:
First Name:WILLEM
Middle Name:M
Last Name:BECKER
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W 7200 S
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1041
Mailing Address - Country:US
Mailing Address - Phone:801-871-0600
Mailing Address - Fax:801-566-1155
Practice Address - Street 1:308 W 7200 S
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1041
Practice Address - Country:US
Practice Address - Phone:801-871-0600
Practice Address - Fax:801-566-1155
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8661295-2801174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian