Provider Demographics
NPI:1972811842
Name:ANITA J DEKKER MD, LLC
Entity type:Organization
Organization Name:ANITA J DEKKER MD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEKKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:541-344-1300
Mailing Address - Street 1:3469 HILYARD ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3815
Mailing Address - Country:US
Mailing Address - Phone:541-344-1300
Mailing Address - Fax:541-610-1890
Practice Address - Street 1:3469 HILYARD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3815
Practice Address - Country:US
Practice Address - Phone:541-344-1300
Practice Address - Fax:541-610-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27842261QP3300X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain