Healthcare Provider Details

I. General information

NPI: 1518226091
Provider Name (Legal Business Name): JOSHUA ARJAAN DEKKER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WHITE SAGE AVE
DELTA UT
84624-8928
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 435-864-2708
  • Fax: 435-864-2855
Mailing address:
  • Phone: 435-979-4371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9378969-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: