Healthcare Provider Details

I. General information

NPI: 1114924032
Provider Name (Legal Business Name): THOMAS J DEGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6841 NE NORTH SHORE RD
BELFAIR WA
98528-9774
US

IV. Provider business mailing address

15520 75TH PL WEST
EDMONDS WA
98026-7702
US

V. Phone/Fax

Practice location:
  • Phone: 425-478-5260
  • Fax: 360-275-3076
Mailing address:
  • Phone: 425-232-6989
  • Fax: 425-374-7728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2017003923
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD00018780
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00018780
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2017003923
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD00018780
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: