Healthcare Provider Details

I. General information

NPI: 1700923406
Provider Name (Legal Business Name): GEORGE M DEGNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N 10TH AVE SUITE 200
STAYTON OR
97383-1311
US

IV. Provider business mailing address

1401 N 10TH AVE SUITE 200
STAYTON OR
97383-1311
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-7151
  • Fax: 503-769-9316
Mailing address:
  • Phone: 503-769-7151
  • Fax: 503-769-9316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD22533
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: