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General NPI Number Information
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NPI Number | 1407827207
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Entity Type | Individual
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Provider Name | JOHN WHITE DECKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 253 COUNTY ROUTE 47
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City | SARANAC LAKE
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State | NY
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Zip | 12983-5403
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Country | US
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Telephone | 518-891-0563
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Fax | 518-897-2700
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Provider Business Mailing Address
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Address Line | 221 COREYS RD
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City | TUPPER LAKE
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State | NY
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Zip | 12986-7723
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Country | US
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Telephone | 518-891-0563
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Fax | 518-897-2700
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 156843
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License Number State | NY
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