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General NPI Number Information
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NPI Number | 1063615268
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Entity Type | Organization
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Legal Business Name | DAVID S DECKER, MD PSC
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4311 BARDSTOWN RD
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City | LOUISVILLE
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State | KY
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Zip | 40218-3233
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Country | US
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Telephone | 502-499-0688
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Fax | 502-499-0689
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Provider Business Mailing Address
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Address Line | 4311 BARDSTOWN RD
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City | LOUISVILLE
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State | KY
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Zip | 40218-3233
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Country | US
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Telephone | 502-499-0688
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Fax | 502-499-0689
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID S DECKER
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Credential | MD
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Telephone | 502-499-0588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 23642
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License Number State | KY
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