Provider Demographics
NPI:1528254166
Name:J THAD DECKER MD PLLC
Entity type:Organization
Organization Name:J THAD DECKER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THADDEUS
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-886-6486
Mailing Address - Street 1:3938 EAST GRANT ROAD
Mailing Address - Street 2:STE 248
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2559
Mailing Address - Country:US
Mailing Address - Phone:520-298-3006
Mailing Address - Fax:520-296-4132
Practice Address - Street 1:6567 EAST CORONDELET
Practice Address - Street 2:STE 455
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6155
Practice Address - Country:US
Practice Address - Phone:520-886-6486
Practice Address - Fax:520-296-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ117552Medicare PIN