Healthcare Provider Details

I. General information

NPI: 1043377609
Provider Name (Legal Business Name): SEAN JAMES DACUS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 ELM ST
SOUTH DEERFIELD MA
01373-1005
US

IV. Provider business mailing address

29 ELM ST
SOUTH DEERFIELD MA
01373-1005
US

V. Phone/Fax

Practice location:
  • Phone: 413-665-6760
  • Fax: 413-665-2101
Mailing address:
  • Phone: 413-665-6760
  • Fax: 413-665-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number236504
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: