Individual
LAWRENCE ANDREW DECKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
3451 N BUTLER AVE, FARMINGTON, NM 87401
(505) 566-1915
(505) 566-1918
Mailing address
3451 N BUTLER AVE, FARMINGTON, NM 87401-2357
(505) 566-1915
(505) 566-1918
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
PA2006-0011
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19375336
—
CO
05
—
66439833
—
NM
05
—
875114
—
AZ
Enumeration date
11/02/2005
Last updated
04/23/2021
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