Provider Demographics
NPI:1730216235
Name:DECKER, ADAM MICHAEL (PA)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:MICHAEL
Last Name:DECKER
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:5656 BEE CAVE RD
Mailing Address - Street 2:SUITE K-200
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5280
Mailing Address - Country:US
Mailing Address - Phone:512-329-6644
Mailing Address - Fax:512-891-8220
Practice Address - Street 1:5656 BEE CAVE RD
Practice Address - Street 2:SUITE K-200
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5280
Practice Address - Country:US
Practice Address - Phone:512-329-6644
Practice Address - Fax:512-891-8220
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA07626363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB150778Medicare PIN
CAWPA15889BMedicare ID - Type UnspecifiedMEDICARE
CAW268Medicare PIN
TXTXB150778Medicare PIN