Basic Information
| Provider Information | |||||||||
| NPI: | 1700174505 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DECKER | ||||||||
| FirstName: | AMELIA | ||||||||
| MiddleName: | KATHLEEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7507 E. TANQUE VERDE ROAD | ||||||||
| Address2: | 101 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207222585 | ||||||||
| FaxNumber: | 5207221097 | ||||||||
| Practice Location | |||||||||
| Address1: | 7507 E. TANQUE VERDE ROAD | ||||||||
| Address2: | 101 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207222585 | ||||||||
| FaxNumber: | 5207221097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2011 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 48898 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.