Provider Demographics
NPI:1417060294
Name:DEGOA, OSCAR (MD)
Entity Type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:
Last Name:DEGOA
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 1:1108 W STATE STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1709
Mailing Address - Country:US
Mailing Address - Phone:269-948-8015
Mailing Address - Fax:269-948-8734
Practice Address - Street 1:1108 W STATE STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1709
Practice Address - Country:US
Practice Address - Phone:269-948-8015
Practice Address - Fax:269-948-8734
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032130207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1044028Medicaid
160084067OtherBCBS
160084067OtherBCBS
A76916Medicare UPIN