Provider Demographics
NPI:1518226091
Name:DEKKER, JOSHUA ARJAAN (DO)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ARJAAN
Last Name:DEKKER
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:PO BOX 30180
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0180
Mailing Address - Country:US
Mailing Address - Phone:435-979-4371
Mailing Address - Fax:
Practice Address - Street 1:130 WHITE SAGE AVE
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:UT
Practice Address - Zip Code:84624-8928
Practice Address - Country:US
Practice Address - Phone:435-864-2708
Practice Address - Fax:435-864-2855
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9378969-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine