Healthcare Provider Details

I. General information

NPI: 1972035491
Provider Name (Legal Business Name): ZACHARY DEGNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 BURKARTH RD
WARRENSBURG MO
64093-3101
US

IV. Provider business mailing address

3901 RAINBOW BLVD DEPARTMENT OF FAMILY MEDICINE
KANSAS CITY KS
66160-8500
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-2500
  • Fax:
Mailing address:
  • Phone: 620-200-1057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number2020023483
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: