Provider Demographics
NPI:1659411379
Name:DEKKER, ANITA JOAN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:JOAN
Last Name:DEKKER
Suffix:
Gender:F
Credentials:MD, MPH
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2852 WILLAMETTE ST. PMB 505
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405
Mailing Address - Country:US
Mailing Address - Phone:541-914-4495
Mailing Address - Fax:541-610-1890
Practice Address - Street 1:360 S GARDEN WAY STE 210
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8186
Practice Address - Country:US
Practice Address - Phone:541-912-0477
Practice Address - Fax:541-610-1890
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI121422083X0100X
OR278242083X0100X, 208VP0000X
ORMD278422083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR140274Medicare PIN