Provider Demographics
NPI:1760473490
Name:DECKER, DEBORAH MAUDE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:MAUDE
Last Name:DECKER
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 1:2903 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8809
Mailing Address - Country:US
Mailing Address - Phone:337-478-6480
Mailing Address - Fax:337-474-9637
Practice Address - Street 1:2903 1ST AVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8809
Practice Address - Country:US
Practice Address - Phone:337-478-6480
Practice Address - Fax:337-474-9637
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022595208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1490857Medicaid
LA5Y935Medicare ID - Type Unspecified
LA1490857Medicaid