Provider Demographics
NPI:1144209784
Name:DECOUD, STEVEN CLAY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CLAY
Last Name:DECOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 800022
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-0022
Mailing Address - Country:US
Mailing Address - Phone:800-953-0104
Mailing Address - Fax:303-765-6670
Practice Address - Street 1:17230 JACKSON CREEK PKWY STE 120
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7302
Practice Address - Country:US
Practice Address - Phone:719-571-7070
Practice Address - Fax:719-570-7079
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0046479207P00000X
CO46479207Q00000X, 207Q00000X
NV7046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86050745Medicaid
CO86050745Medicaid
CO301985Medicare PIN