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General NPI Number Information
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NPI Number | 1093706699
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Entity Type | Individual
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Provider Name | LAWRENCE ANDREW DECKER PAC
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 3451 N BUTLER AVE
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City | FARMINGTON
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State | NM
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Zip | 87401
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Country | US
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Telephone | 505-566-1915
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Fax | 505-566-1918
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Provider Business Mailing Address
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Address Line | 3451 N BUTLER AVE
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City | FARMINGTON
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State | NM
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Zip | 87401-2357
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Country | US
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Telephone | 505-566-1915
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Fax | 505-566-1918
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | PA2006-0011
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License Number State | NM
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