Provider Demographics
NPI:1205986882
Name:SANDOVAL, STEPHEN DEGNAN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DEGNAN
Last Name:SANDOVAL
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 1:321 N HIGHLAND AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7378
Mailing Address - Country:US
Mailing Address - Phone:903-870-7936
Mailing Address - Fax:903-957-0367
Practice Address - Street 1:321 N HIGHLAND AVE
Practice Address - Street 2:STE 120
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7378
Practice Address - Country:US
Practice Address - Phone:903-870-7936
Practice Address - Fax:903-957-0367
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6863207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196461101Medicaid
OK200198900AMedicaid
TX8BJ960OtherBLUE CROSS BLUE SHIELD
TX8L1320Medicare PIN
TX8BJ960OtherBLUE CROSS BLUE SHIELD