Provider Demographics
NPI:1164750287
Name:GEORGE B DECKEY, PC
Entity Type:Organization
Organization Name:GEORGE B DECKEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:BASHIR
Authorized Official - Last Name:DECKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-726-5141
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2300
Mailing Address - Country:US
Mailing Address - Phone:928-726-5141
Mailing Address - Fax:928-726-2848
Practice Address - Street 1:2435 S AVE A
Practice Address - Street 2:SUITE B
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7175
Practice Address - Country:US
Practice Address - Phone:928-276-5141
Practice Address - Fax:928-726-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1457344681Medicare UPIN
AZZMD21287Medicare UPIN