Provider Demographics
NPI:1285744490
Name:DEKKER, ANTHONY H (DO)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:H
Last Name:DEKKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 495
Mailing Address - Street 2:FORT BELVOIR COMMUNITY HOSPITAL
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-0495
Mailing Address - Country:US
Mailing Address - Phone:602-762-1908
Mailing Address - Fax:602-263-1637
Practice Address - Street 1:4212 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5319
Practice Address - Country:US
Practice Address - Phone:602-762-1908
Practice Address - Fax:602-263-1637
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007766204D00000X, 207P00000X, 207Q00000X, 207QA0000X, 207QA0401X, 207QG0300X, 207QS0010X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0713420OtherBCBS
AZ460212Medicaid
AZ8HZ25EMedicare ID - Type UnspecifiedPART B PIMC
AZ8EZ34PMedicare ID - Type UnspecifiedPART B YAVAPAI
AZ8HE003Medicare ID - Type UnspecifiedPART B SALT RIVER
AZ030078Medicare Oscar/Certification
AZD14453Medicare UPIN
AZ460212Medicaid