Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | M6863 | TX |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | M6863 | TX |
NPI | 1205986882 |
---|---|
Provider Name | Dr. Stephen Degnan Sandoval |
First Address | Sherman, TX 75092-7378 |
Second Address | Sherman, TX 75092-7378 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 02/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
196461101 | (05) | TX |
200198900A | (05) | OK |
8BJ960 | BLUE CROSS BLUE SHIELD (01) | TX |