Provider Demographics
NPI:1336290055
Name:DECKER, DONALD ALAN (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ALAN
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:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:KILA
Mailing Address - State:MT
Mailing Address - Zip Code:59920
Mailing Address - Country:US
Mailing Address - Phone:406-755-2823
Mailing Address - Fax:
Practice Address - Street 1:6575 HWY 93 S
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937
Practice Address - Country:US
Practice Address - Phone:406-863-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7759207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0048127Medicaid
MT0048127Medicaid