Provider Demographics
NPI:1871546010
Name:DECKER, JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:DECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:123 DI SALVO AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1717
Mailing Address - Country:US
Mailing Address - Phone:408-279-4664
Mailing Address - Fax:408-279-0464
Practice Address - Street 1:123 DI SALVO AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1717
Practice Address - Country:US
Practice Address - Phone:408-279-4664
Practice Address - Fax:408-279-0464
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG11266207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA181912104OtherMEDICARE RAILROAD
CA00G112660Medicare PIN
CAA38296Medicare UPIN