MEDICARE: DR. SEAN JAMES DACUS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	236504	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	J43494	OTHER	MA	BCBS LEGACY NUMBER

General Provider Information

NPI Number	:	1043377609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN JAMES DACUS D.O.

Provider Business Mailing Address
First Line	:	29 ELM ST
Second Line	:
City	:	SOUTH DEERFIELD
State	:	MA
Zip	:	01373-1005
Country	:	US
Telephone Number	:	413-665-6760
Fax Number	:	413-665-2101

Provider Business Practice Location Address
First Line	:	29 ELM ST
Second Line	:
City	:	SOUTH DEERFIELD
State	:	MA
Zip	:	01373-1005
Country	:	US
Telephone Number	:	413-665-6760
Fax Number	:	413-665-2101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	04/01/2016

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