Provider Demographics
NPI:1386973451
Name:DECKARD, DANNY TREW (PA)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:TREW
Last Name:DECKARD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:832 N WINNETKA AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-3747
Mailing Address - Country:US
Mailing Address - Phone:214-520-8833
Mailing Address - Fax:214-520-2956
Practice Address - Street 1:3500 OAK LAWN
Practice Address - Street 2:STE 600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4308
Practice Address - Country:US
Practice Address - Phone:214-520-8833
Practice Address - Fax:214-520-2956
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA02811363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical