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General NPI Number Information
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NPI Number | 1356204622
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Entity Type | Individual
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Provider Name | JEFFERY DECKER
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Gender | Male
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 42134 W CORVALIS LN
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City | MARICOPA
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State | AZ
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Zip | 85138-3292
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Country | US
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Telephone | 737-313-9194
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Fax |
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Provider Business Mailing Address
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Address Line | 42134 W CORVALIS LN
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City | MARICOPA
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State | AZ
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Zip | 85138-3292
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Country | US
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Telephone | 737-313-9194
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Fax |
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State |
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