Provider Demographics
NPI:1639230287
Name:DECKEY, GOWAN JESSEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GOWAN
Middle Name:JESSEN
Last Name:DECKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2359 S 22ND DR
Mailing Address - Street 2:STE 2
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:928-344-4800
Mailing Address - Fax:928-726-2377
Practice Address - Street 1:2359 S 22ND DR
Practice Address - Street 2:STE 2
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-344-4800
Practice Address - Fax:928-726-2377
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20484208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0340800OtherBCBS
AZ139768Medicaid