Basic Information
| Provider Information | |||||||||
| NPI: | 1730432345 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MICHAEL G. DEGNAN, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DEGNAN FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 181 WEBB DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DAVENPORT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338373964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634191235 | ||||||||
| FaxNumber: | 8634199525 | ||||||||
| Practice Location | |||||||||
| Address1: | 181 WEBB DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DAVENPORT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338373944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634191235 | ||||||||
| FaxNumber: | 8634199525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2012 | ||||||||
| LastUpdateDate: | 05/10/2017 | ||||||||
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| AuthorizedOfficialLastName: | DEGNAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8634191235 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.