Basic Information
Provider Information
NPI: 1306914445
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DECHANT
FirstName: PAUL
MiddleName: F
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 600 COFFEE RD
Address2:  
City: MODESTO
State: CA
PostalCode: 953554201
CountryCode: US
TelephoneNumber: 2095241211
FaxNumber:  
Practice Location
Address1: 600 COFFEE RD
Address2:  
City: MODESTO
State: CA
PostalCode: 953554201
CountryCode: US
TelephoneNumber: 2095241211
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/30/2006
LastUpdateDate: 03/02/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XG53632CAN Allopathic & Osteopathic PhysiciansFamily Medicine 
207P00000XG53632CAY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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