Provider Demographics
NPI:1316033707
Name:DECKER, PAUL WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:WAYNE
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 1:17521 ST LUKES WAY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8039
Mailing Address - Country:US
Mailing Address - Phone:936-447-9452
Mailing Address - Fax:936-447-9422
Practice Address - Street 1:17521 ST LUKES WAY
Practice Address - Street 2:SUITE 170
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8039
Practice Address - Country:US
Practice Address - Phone:936-447-9452
Practice Address - Fax:936-447-9422
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042298201Medicaid
TX83872JMedicare PIN
TX042298201Medicaid
GA80125967Medicare PIN