Individual
DR. MIRANDA DECKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
535 GANDY ST NE, RUSSELLVILLE, AL 35653-1965
(256) 332-1120
(256) 332-1198
Mailing address
PO BOX 516, 535 GANDY ST, RUSSELLVILLE, AL 35653-0516
(256) 332-1120
(256) 332-1198
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
28146
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009911825
—
AL
01
—
510-06343
BCBS
AL
Enumeration date
08/14/2007
Last updated
10/25/2024
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