Healthcare Provider Details

I. General information

NPI: 1568635365
Provider Name (Legal Business Name): STEPHEN M DECHTER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STEVE M DECHTER DO

II. Dates (important events)

Enumeration Date: 04/12/2008
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9915 SANDIFUR PKWY STE B
PASCO WA
99301-8941
US

IV. Provider business mailing address

711 S AUBURN ST
KENNEWICK WA
99336-5665
US

V. Phone/Fax

Practice location:
  • Phone: 509-586-2828
  • Fax: 509-586-2525
Mailing address:
  • Phone: 509-586-2828
  • Fax: 509-586-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDO161115
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A12083
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOP60328984
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: