Provider Demographics
NPI:1932483740
Name:DECKER, MICHAEL D (DPH)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:DECKER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6712 CYPRESS HOLW
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-1300
Mailing Address - Country:US
Mailing Address - Phone:405-210-9021
Mailing Address - Fax:405-359-3612
Practice Address - Street 1:1400 E 2ND ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5321
Practice Address - Country:US
Practice Address - Phone:405-216-9672
Practice Address - Fax:405-216-9660
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist