Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RX0202X | Medical Oncology | 2010-00391 | NC |
Y | 207RX0202X | Medical Oncology | 2013042940 | MO |
NPI | 1104038249 |
---|---|
Provider Name | Shaun C Donegan |
First Address | Saint Louis, MO 63141-8222 |
Second Address | Saint Louis, MO 63141-8222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 02/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
158Y9 | BCBS (01) | NC |
5914657 | (05) | NC |
P008500258 | RAILROAD MEDICARE (01) | NC |