Provider Demographics
NPI:1114924032
Name:DEGAN, THOMAS J (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:DEGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15520 75TH PL WEST
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7702
Mailing Address - Country:US
Mailing Address - Phone:425-232-6989
Mailing Address - Fax:425-374-7728
Practice Address - Street 1:6841 NE NORTH SHORE RD
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9774
Practice Address - Country:US
Practice Address - Phone:425-478-5260
Practice Address - Fax:360-275-3076
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017003923207XX0005X, 207X00000X
WAMD00018780207X00000X, 174400000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8953624OtherMEDICARE
WAG8953624OtherMEDICARE