Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2017003923 | MO |
Y | 207X00000X | Orthopaedic Surgeon | MD00018780 | WA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 2017003923 | MO |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD00018780 | WA |
NPI | 1114924032 |
---|---|
Provider Name | Thomas J Degan |
First Address | Edmonds, WA 98026-7702 |
Second Address | Belfair, WA 98528-9774 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 12/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A04362 | (02) | WA |
G8953624 | MEDICARE (01) | WA |