Provider Demographics
NPI:1407827207
Name:DECKER, JOHN WHITE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WHITE
Last Name:DECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:221 COREYS RD
Mailing Address - Street 2:
Mailing Address - City:TUPPER LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12986-7723
Mailing Address - Country:US
Mailing Address - Phone:518-891-0563
Mailing Address - Fax:518-897-2700
Practice Address - Street 1:253 COUNTY ROUTE 47
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5403
Practice Address - Country:US
Practice Address - Phone:518-891-0563
Practice Address - Fax:518-897-2700
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156843207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00811096Medicaid
NY331066683OtherEMPIRE PLAN
NY33106683OtherEXCELLUS
NYP0018406OtherRR MEDICARE
NY000490110003OtherBLUE SHIELD OF NORTHEASTE
NY331066683OtherRMSCO
NY7M5621OtherEMPIRE
NY000490110003OtherBSNENY
NY049001OtherMVP
NYP0018406OtherRR MEDICARE
NY7M5621OtherEMPIRE