Provider Demographics
NPI:1558322941
Name:DECKER, TIMOTHY B (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:B
Last Name:DECKER
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 1049
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-1049
Mailing Address - Country:US
Mailing Address - Phone:256-996-1337
Mailing Address - Fax:256-638-4634
Practice Address - Street 1:PO BOX 1049
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986-1049
Practice Address - Country:US
Practice Address - Phone:256-996-1337
Practice Address - Fax:256-638-4634
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALDO.92207Q00000X
ALALDO92207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51080578OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL000080578Medicaid
AL1558322941Medicaid
AL000080578Medicaid