Provider Demographics
NPI:1558322941
Name:DECKER, TIMOTHY BRIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:BRIAN
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:PO BOX 1049
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-1049
Mailing Address - Country:US
Mailing Address - Phone:256-638-1100
Mailing Address - Fax:256-638-7804
Practice Address - Street 1:511 MAIN ST W
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986-5944
Practice Address - Country:US
Practice Address - Phone:256-638-1100
Practice Address - Fax:256-638-7804
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALDO92207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51080578OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL000080578Medicaid
ALC78739Medicare UPIN
AL000080578Medicaid