Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101007766 | MI |
N | 207P00000X | Emergency Physician | 5101007766 | MI |
N | 207Q00000X | Family Doctor | 5101007766 | MI |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 5101007766 | MI |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 5101007766 | MI |
N | 207QS0010X | Family Doctor - Sports Medicine | 5101007766 | MI |
NPI | 1285744490 |
---|---|
Provider Name | Dr. Anthony H Dekker |
First Address | Fort Belvoir, VA 22060-0495 |
Second Address | Phoenix, AZ 85016-5319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 09/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
460212 | (05) | AZ |
AZ0713420 | BCBS (01) | AZ |
D14453 | (02) | AZ |