Individual
DR. JACK HUDSON DECKARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5150 N PORT WASHINGTON RD, STE 220, GLENDALE, WI 53217-5474
(414) 961-0089
(414) 961-1043
Mailing address
5150 N PORT WASHINGTON RD, STE 220, GLENDALE, WI 53217-5474
(414) 961-0089
(414) 961-1043
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
24495
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30464900
—
WI
Enumeration date
06/15/2006
Last updated
08/31/2010
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