MEDICARE: TERENCE DEGAN, MD, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G54148	CA

General Provider Information

NPI Number	:	1871835785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERENCE DEGAN, MD, INC

Provider Business Mailing Address
First Line	:	1216 SUNCAST LN
Second Line	:	SUITE 1
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9668
Country	:	US
Telephone Number	:	916-933-5028
Fax Number	:	916-933-8747

Provider Business Practice Location Address
First Line	:	1216 SUNCAST LN
Second Line	:	SUITE 1
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9668
Country	:	US
Telephone Number	:	916-933-5028
Fax Number	:	916-933-8747

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. TERENCE DEGAN
Credential	:	M.D.
Telephone Number	:	916-933-5028

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	03/19/2013

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