Basic Information
| Provider Information | |||||||||
| NPI: | 1669455028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEGN | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 32364 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379302364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003432599 | ||||||||
| FaxNumber: | 8655312722 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 E WILLIAMS AVE | ||||||||
| Address2: | |||||||||
| City: | FALLON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894063052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754233151 | ||||||||
| FaxNumber: | 7754282914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2005 | ||||||||
| LastUpdateDate: | 06/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 043127 | CT | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 11820 | NV | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 100509685 | 05 | NV | MEDICAID | P00337401 | 01 | RAILROAD MEDICARE | OTHER | CC4755 | 01 | NV | BCBSNV | OTHER |