Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 26265 | TX |
N | 1223G0001X | General Practice | DN013362 | GA |
N | 213EG0000X | General Practice | DN013362 | GA |
Y | 1223P0300X | Periodontist | 26565 | TX |
N | 1223P0300X | Periodontist | DNO13362 | GA |
NPI | 1033120506 |
---|---|
Provider Name | Dr. John Frederick Decker |
First Address | Ft Hood, TX 76544 |
Second Address | Ft Hood, TX 76544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 23/05/2017 |