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Individual
JOHN A DECLUE
Active
Individual
JOHN A DECLUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
037522
GA
207Q00000X
Family Medicine Physician
Primary
2014010401
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00571326F
—
GA
05
—
1235104886
—
MO
01
—
124920003
MEDICARE PTAN
MO
01
—
480095
BLUECROSSBLUESHIELD
GA
Enumeration date
02/17/2006
Last updated
06/18/2024
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