Provider Demographics
NPI:1922235167
Name:DEGANI, JASON MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MICHAEL
Last Name:DEGANI
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 1:12563 FULFORD CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-4190
Mailing Address - Country:US
Mailing Address - Phone:505-453-7484
Mailing Address - Fax:
Practice Address - Street 1:UNM DEPARTMENT OF ANESTHESIOLOGY MSC10 6000
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-5533
Practice Address - Country:US
Practice Address - Phone:505-272-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2019-0203207L00000X
NH19624207L00000X
MEMD23081207L00000X
TN62350207L00000X
COCDRH.0053704207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology