Provider Demographics
NPI:1649799644
Name:DECKER, BOYD JOSEPH (CAA)
Entity type:Individual
Prefix:
First Name:BOYD
Middle Name:JOSEPH
Last Name:DECKER
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N884 KNEPPRATH RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53013-1169
Mailing Address - Country:US
Mailing Address - Phone:920-889-8753
Mailing Address - Fax:
Practice Address - Street 1:975 PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-9201
Practice Address - Country:US
Practice Address - Phone:262-329-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100071883Medicaid