Provider Demographics
NPI:1861489833
Name:DECKER, JASON EVERETT (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:EVERETT
Last Name:DECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2017 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5501
Mailing Address - Country:US
Mailing Address - Phone:281-485-9990
Mailing Address - Fax:281-485-9469
Practice Address - Street 1:2017 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5501
Practice Address - Country:US
Practice Address - Phone:281-485-9990
Practice Address - Fax:281-485-9469
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1558208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL1558OtherLICENSE NUMBER
TX145224503OtherMEDICAID PROVIDER ID
TXH37424Medicare UPIN