Provider Demographics
NPI:1457344681
Name:DECKEY, GEORGE BASHIR
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:BASHIR
Last Name:DECKEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7127
Mailing Address - Country:US
Mailing Address - Phone:928-344-2000
Mailing Address - Fax:283-361-3959
Practice Address - Street 1:2270 S RIDGEVIEW DR STE 201
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8880
Practice Address - Country:US
Practice Address - Phone:928-344-5055
Practice Address - Fax:928-336-6290
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2021-09-13
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
AZ21287208600000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZMD21287Medicare ID - Type Unspecified
AZZMD21287Medicare PIN