MEDICARE: JOHN THADDEUS DECKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	25939	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578512257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN THADDEUS DECKER MD

Provider Business Mailing Address
First Line	:	2424 N WYATT DR STE 260
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-6118
Country	:	US
Telephone Number	:	520-795-8080
Fax Number	:	520-323-6237

Provider Business Practice Location Address
First Line	:	6452 E CARONDELET DR STE 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-2262
Country	:	US
Telephone Number	:	520-323-0333
Fax Number	:	520-323-5036

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	06/18/2024

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