Healthcare Provider Details

I. General information

NPI: 1174508493
Provider Name (Legal Business Name): BARRY J. DECKER, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 LAKE BALDWIN LN
ORLANDO FL
32814-6651
US

IV. Provider business mailing address

942 LAKE BALDWIN LN
ORLANDO FL
32814-6651
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-5201
  • Fax: 407-898-5233
Mailing address:
  • Phone: 407-898-5201
  • Fax: 407-898-5233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BARRY JOHN DECKER
Title or Position: PRESIDENT
Credential: MD
Phone: 407-898-5201