Provider Demographics
NPI:1902851538
Name:MICHAEL E. DECHERD, M.D., P.A.
Entity Type:Organization
Organization Name:MICHAEL E. DECHERD, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DECHERD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-495-4100
Mailing Address - Street 1:PO BOX 1073
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78294-1073
Mailing Address - Country:US
Mailing Address - Phone:210-495-4100
Mailing Address - Fax:210-495-4114
Practice Address - Street 1:414 W SUNSET RD
Practice Address - Street 2:SUITE 215
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1756
Practice Address - Country:US
Practice Address - Phone:210-495-4100
Practice Address - Fax:210-495-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00153XMedicare PIN
TXI12979Medicare UPIN