Healthcare Provider Details

I. General information

NPI: 1134217375
Provider Name (Legal Business Name): SEAN M DEGNAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 HWY 50 SUITE 100
STATELINE NV
89449
US

IV. Provider business mailing address

PO BOX 5757
STATELINE NV
89449-5757
US

V. Phone/Fax

Practice location:
  • Phone: 775-588-3300
  • Fax: 775-588-3353
Mailing address:
  • Phone: 775-588-3300
  • Fax: 775-588-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number5488
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: