Provider Demographics
NPI:1639132301
Name:DECKER, JUSTIN THOMAS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:THOMAS
Last Name:DECKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 JARRETT WHITE RD
Mailing Address - Street 2:TRIPLER ARMY MED CENTER ATTEN: MCHK-QS
Mailing Address - City:TRIPLER AMC
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5000
Mailing Address - Country:US
Mailing Address - Phone:808-433-2460
Mailing Address - Fax:808-433-1588
Practice Address - Street 1:501 N PARK AVE STE 120
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5034
Practice Address - Country:US
Practice Address - Phone:520-284-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN