Organization
JOSEPH F DECKER PROFESSIONAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH F DECKER MD (PRESIDENT)
(435) 753-3277
Entity
Organization
Contact information
Practice address
164 S 5TH, MONTPELIER, ID 83254
(435) 753-3277
Mailing address
1365 SUMAC DR, LOGAN, UT 84321-4819
(435) 753-3277
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M3611
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010001738
BLUE SHIELD
—
01
—
80515
BLUE CROSS
ID
Enumeration date
01/24/2007
Last updated
08/22/2020
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