Provider Demographics
NPI:1225038334
Name:DECKER, PHILIP ANTHONY (MD)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ANTHONY
Last Name:DECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 NEW HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1320
Mailing Address - Country:US
Mailing Address - Phone:270-683-3720
Mailing Address - Fax:270-686-7331
Practice Address - Street 1:2801 NEW HARTFORD RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1320
Practice Address - Country:US
Practice Address - Phone:270-683-3720
Practice Address - Fax:270-686-7331
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056579A208600000X, 2086S0129X
KY373892086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200386620OtherMOLINA
KY611059472OtherDART
KY64052632Medicaid
611059472OtherUMWA
IN200386620Medicaid
IN611059472107OtherCARESOURCE
KY0000000228388OtherANTHEM
020053272OtherRAILROAD MEDICARE
KY0033512Medicare ID - Type Unspecified
IN200386620OtherMOLINA
IN630980HMedicare PIN