Provider Demographics
NPI:1457349755
Name:DECKER, WILLIAM E (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:DECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 E BROADWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7166
Mailing Address - Country:US
Mailing Address - Phone:573-874-7800
Mailing Address - Fax:573-443-3627
Practice Address - Street 1:601 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-5972
Practice Address - Country:US
Practice Address - Phone:660-827-9538
Practice Address - Fax:660-826-7698
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040054862085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208741306Medicaid
33552015OtherBCBS OF KC
190520OtherBCBS OF MO
5132415OtherAETNA
65201A008OtherTRICARE
663547OtherHEALTHLINK
I04386OtherMERCY HEALTH PLANS
214339OtherGHP
MO917980635Medicare PIN
65201A008OtherTRICARE
5132415OtherAETNA
663547OtherHEALTHLINK
P00628005Medicare PIN
MOP00132598Medicare PIN
MO917985236Medicare PIN
MO917982700Medicare PIN
MO127530006Medicare PIN