Provider Demographics
NPI:1295834950
Name:DECKER, JAMES D (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:DECKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-4406
Mailing Address - Country:US
Mailing Address - Phone:620-669-6690
Mailing Address - Fax:620-694-4512
Practice Address - Street 1:239 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:KS
Practice Address - Zip Code:67579-1916
Practice Address - Country:US
Practice Address - Phone:620-278-2123
Practice Address - Fax:620-278-2712
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-24538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F97180Medicare UPIN
53768Medicare ID - Type Unspecified