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General NPI Number Information
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NPI Number | 1366597866
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Entity Type | Organization
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Legal Business Name | JOSEPH F DECKER PROFESSIONAL CORP
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 164 S 5TH
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City | MONTPELIER
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State | ID
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Zip | 83254
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Country | US
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Telephone | 435-753-3277
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Fax |
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Provider Business Mailing Address
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Address Line | 1365 SUMAC DR
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City | LOGAN
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State | UT
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Zip | 84321-4819
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Country | US
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Telephone | 435-753-3277
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH F DECKER
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Credential | MD
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Telephone | 435-753-3277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M3611
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License Number State | ID
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