Provider Demographics
NPI:1205039807
Name:DECKER, DANIEL B (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:DECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:19 MEDICAL PLZ STE 40
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2962
Mailing Address - Country:US
Mailing Address - Phone:870-232-5215
Mailing Address - Fax:870-232-5240
Practice Address - Street 1:140 HIGHWAY 201 N
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3158
Practice Address - Country:US
Practice Address - Phone:870-232-5215
Practice Address - Fax:870-232-5240
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-6412208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR188791001Medicaid
BP1-0026522OtherINSTITUTIONAL PERMIT